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Business-continuity_blizzard-after_JasonEppink-flickrBy now you have heard the term El Niño used so much you may be numb as to how it might impact your business in the coming months. The Weather Channel reports the strongest El Niño on record will continue to influence weather through March of this year. We have seen above normal temperatures interrupted by large snowstorms and massive snow accumulation; recent Winter Storm Jonas, which hit heaviest in the Northeast, with its impact stretching through the mid-Atlantic region, the South and the Ohio Valley, is now in the record books for snow accumulation in many areas, and preliminary estimates say the storm, including damage costs from flooding, caused an estimated $1 billion in losses. In the Midwest, we have already seen record flooding and additional projections for heavy snowfall in the coming weeks. In the West, the El Niño could bring flooding, mudslides and other weather-related incidents due to heavy rain after a prolonged drought.

At Vericlaim, part of the Sedgwick family of companies, our veteran team has years of combined experience dealing with losses from every kind of weather event possible. We make it our business to help you prepare and deal with a natural disaster from a catastrophic claim perspective.

I recently shared at a conference that the two things a business must do to be prepared for weather-related events are to have a business continuity plan and review the insured values and scope of coverage. We are seeing volatile weather in the news every day. Volatile weather obviously has a significant impact on claims activity, but it also ultimately has a near-term impact on coverage and pricing. Twenty or thirty years ago, if you were insuring ten properties and 100,000 employees, you faced one set of business challenges. Today, with the growth of emerging markets and the expansion of the global supply chain, the equation has changed. For instance, now if you see flooding overseas, such as in Thailand a few years ago, that isolated regional weather event becomes a major risk and economic event in the U.S. A major wakeup call for the U.S. has been in realizing how worldwide weather events impact the supply chain and risk contingency planning.

So what should you do today to prepare for these new crisis events related to weather volatility? Plan, plan, plan, prepare, prepare, prepare – in our experience, there is no level of preparedness that is too much. As well-prepared as many risk management departments are, it is rare to encounter companies that are over-prepared in this regard and far more common to find those that have not prepared enough. When you sit down and plan today, you are planning for a different set of variables than businesses were in the recent past.

I see two major areas where companies are generally under-prepared:

  1. The action plans are too high-level, and don’t address a broad enough or deep enough set of possible disaster circumstances
  2. Almost everyone underestimates the value of the physical and economic assets they are protecting

Replacing a plant or building, bringing thousands of employees back to business or addressing a major supply chain interruption is often accompanied by a systematic understatement of values. In some cases, this problem is caused by a lack of in-depth planning that adversely impacts the ability to mitigate damages and losses. In other cases, the cause is as simple as getting poor estimates of the true economic loss of a potential contingency (not enough coverage) or coverage that is too narrow, particularly as it relates to contingent business interruption. Whether the result of a direct event or a contingent weather or catastrophic event, it is imperative that the risk management community spends more time thinking about how to get back in business after a major loss event and the true economic costs of doing so.

How often should you update your business continuity plan based on our changing world?
I don’t think employers need to have a set time frame for this activity. More important is to update your business continuity plan once really well, and then reevaluate anytime you see material change in either the risk environment or the profile of the assets that are being protected, both physical and economic.

What is the biggest mistake made in continuity planning?
Many businesses forget to think contingencies. It is easy to think, “If a hurricane hits my building, what will I do?” What many employers don’t think about is, for instance, “What if a hurricane disrupts a transportation hub that affects one of my key suppliers?” Bring a risk professional to the table and a strong partner to help you think through all the possibilities – specific perils and scenarios, not just generic, common issues. And the risk profiles differ greatly for employers across vertical markets; business risks for a retailer are drastically different from those of a financial institution, manufacturer or distributor.

I will close by saying again – get a business continuity plan in place. If you don’t make any other resolutions for 2016, make this your focus and do it sooner rather than later. Getting a plan in place will save you time, money and worry when – and not if – that event happens to yours or another business.

What questions do you have about business continuity planning? We have a seasoned group of colleagues who can answer those questions and give you the guidance to get your plan in place. Remember plan, plan, plan and prepare, prepare, prepare and make 2016 your year to be ready.

Mike Arbour
CEO, Vericlaim, a Sedgwick company

For additional perspective on business income losses and how to prepare for risk factors, read our recent article, “When civil unrest breaks out,” in the edge magazine. 

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Scenefor16As we move into the new year, I am excited about all the great things I believe will happen in our industry. Taking care of people is at the heart of everything we do at Sedgwick – from ensuring injured and ill workers have access to the right healthcare resources to meeting the needs of clients, consumers and the industry at large. We are committed to elevating the discussion, sharing information and strategies centered on caring for people; making a difference through easily accessible, streamlined risk management, benefit and productivity solutions; and utilizing advanced technology.

Sedgwick’s The scene for 2016 list illustrates how taking care of the people served by our industry remains critical to improving results for everyone. We believe these evolving areas – employee health and wellness, technology for improving care and safety, legislative developments affecting claim costs and access to care, market challenges and emerging risks – will be significant, and we join other industry experts in closely monitoring and exploring them throughout the year.

Focusing on employee health and wellness – People are the heart and soul of each organization and as such prioritizing employee health and wellness will be critical to the success of employers.

  1. Patient advocacy
  2. Responsive model of care
  3. Pharmacy management and patient safety
  4. Mental health risks

Leveraging smarter technology – Advancements in technology will continue to impact and improve how people communicate, stay connected and use data to change behaviors and improve results.

  1. Prescriptive analytics
  2. Autonomous technology
  3. Connected health
  4. Cutting-edge technology

Responding to legislative changes – The people in power and the laws they enact will significantly affect the industry in 2016 and beyond.

  1. Shift in the political landscape
  2. Complexity in state workers’ compensation systems
  3. Affordable Care Act (ACA)
  4. Employment laws

Managing market challenges and emerging risks – Individuals and organizations will continue to adapt to market changes and manage challenges from many sources.

  1. Global supply chain
  2. Brand and reputational challenges
  3. Workforce demographics
  4. Sharing economy

I encourage you to read more of the scene for 2016 list and Sedgwick’s industry thought leadership; visit sedgwick.com/scenefor2016 and read our blog each week for the latest take on developing industry trends.

Dave North Scene for 2016

 

 

 

 

 

 

 

 

 

Dave North, President and CEO

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Antipsychotics_graphicAntipsychotics are medications used for the treatment of acute and chronic psychosis and other psychotic conditions. Besides their defined indication by the Food and Drug Administration, antipsychotics are often used and misused for off-label conditions such as depression, post-traumatic stress disorder and insomnia. Like all other medications, they have their fair share of side effects and drug interactions. 

According to a 2014 drug trends report, antipsychotics accounted for 2.3% of the total drug cost for workers’ compensation claims, with a 2.0% increase in the average cost per prescription in 2014 compared to 2013. Not only are these medications expensive, but their misuse is growing.1

In the injury claims we have seen at Sedgwick, these drugs are not always prescribed by a psychiatrist or a behavioral health expert, and patients often do not receive follow-up by a multi-disciplinary team. Antipsychotics are usually prescribed by primary care physicians who are not trained in behavioral management and not familiar with the side effects and drug interactions.A lot of adverse events are often overlooked and drug interactions are not closely monitored.3 Just recently, Sedgwick’s staff pharmacists were referred to a case in which the primary care provider was prescribing his patient anticonvulsants as mood stabilizers, antidepressants for depression and sleep, and antipsychotics for depression and insomnia. The patient was also being followed by a pain specialist who was prescribing opioids, anxiolytics and stimulants. Additionally, the physicians were not exchanging progress notes and the patient was unaware of the dangerous combination he was taking.

This patient was being prescribed medications to help with the side effects of his other medications. Psychosis was not a documented diagnosis for him, yet he was taking two antipsychotic medications to help with sleep and depression. A psychiatric evaluation was never part of the patient’s progress notes nor was there a risk assessment in the medical record to determine his risk for drug abuse or overdose. After one of Sedgwick’s staff pharmacists spoke with both providers, both of the psychotropic medications were discontinued and the patient was referred to a psychiatrist to help manage his depression and anxiety, which were not related to his workers’ compensation injury.

Antipsychotics are generally not recommended for workers’ compensation injuries. While there is some data to support use for treatment-resistant depression, there is insufficient data to support their use as standalone therapy. The patient population that we help monitor should rarely be on any psychotropic medications, as studies show that the use of these agents in the treatment of workers’ compensation injuries offers little to no benefit in functional improvement or quality of life.4, 5

Based on our experience with these types of cases, the use of antipsychotic medications often does more harm than good for the injured employee. Risk managers must evaluate the behavioral health and prescription drug management components of their claims and healthcare programs. A team of physicians, pharmacists and specially trained clinicians must be systematically connected with the claims administration professionals and their systems in order to address life-threatening situations quickly. Behavioral health and pharmacy solutions prompt prevention of these types of dangerous situations and provide key intervention.

Technology interfaces must be equipped to systematically sound the alarm and the first responders must include a multi-disciplinary team of medical experts. Sedgwick’s pharmacy clinical review program includes point-of-sale interventions managed by our nurses who review medications prior to dispensing. Drug alerts interface with our proprietary claims management system and when an alert is received, our clinical team will confirm it is the correct treatment for the injury, work with the physician to make any necessary prescription changes – and ultimately ensure the injured employee’s safety.

Reema Hammoud
PharmD, BCPS, Director, Clinical Pharmacy
Sedgwick

Sources
2. Spielmans GI, Berman MI, Linardatos E, Rosenlicht NZ, Perry A, Tsai AC. Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes. PLoS Med. 2013 Mar; 10 (3):e1001403. doi: 10.1371/journal.pmed.1001403.
3. Jin H, Shih PA, Golshan S, Mudaliar S, Henry R, Glorioso DK, Arndt S, Kraemer HC, Jeste DV. Comparison of longer-term safety and effectiveness of 4 atypical antipsychotics in patients over age 40: a trial using equipoise-stratified randomization. J Clin Psychiatry. 2013 Jan; 74(1):10-8. doi: 10.4088/JCP.12m08001.
4. Hellerstein DJ, “Aripiprazole as an Adjunctive Treatment for Refractory Major Depression,” Prog Neuropsychopharmacol Biol Psychiatry, 2004, 28(8):1347-8. NCBI website – PubMed 15588762.
5. Ketter TA, Wang PW, Chandler RA, et al, “Adjunctive Aripiprazole in Treatment-Resistant Bipolar Depression,” Ann Clin Psychiatry, 2006, 18(3):169-72. NCBI website – PubMed 16923655.

*This article was originally published in the edge issue 003

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OSHA offers suggestions for preventing workplace assaults in healthcare settings.

OSHA offers suggestions for preventing workplace assaults in healthcare settings. (image courtesy of OSHA.gov)

Despite several unfortunate and tragic instances in the news recently, workplace violence rates as a whole have been declining. According to the National Council on Compensation Insurance (NCCI) in its 2012 research brief Violence in the Workplace, the rates of workplace violence for both homicides and assaults have dropped. From 1993 to 2009, workplace homicides fell 59% and workplace assaults declined 37%.

However, while the share of workplace injuries caused by assaults compared to overall workplace injuries is small, it is increasing – with the healthcare profession particularly at risk. NCCI reports, from 1999 to 2009, total lost time work injuries fell by 43%, but workplace assaults declined only 7%.

No industry is at bigger risk for workplace assaults than the healthcare industry – four times greater than other professions, according to the Occupational Safety and Health Administration (OSHA). Consider:

  • In November 2014, a 68-year-old patient in Minnesota went on a rampage with a metal bar and injured four nurses, two of which were hospitalized, one with a collapsed lung.
  • In September 2015, a hospital patient in South Carolina was arrested after assaulting 14 nurses and staff members including striking victims with closed fists, throwing and swinging objects at staff and grabbing one female victim by the hair and throwing her to the ground.

NCCI data indicates nearly two-thirds of all workplace assaults occur in the health services industry. Healthcare support personnel, including nursing and home health aides, are the occupation most at risk for a workplace assault, followed by healthcare practitioners and technicians. And a vast majority of these assaults are to female employees.

According to NCCI, the highest incident rates within the healthcare industry are in psychiatric and substance abuse hospitals with 75 assaults per 10,000 workers in 2009, followed by other residential care facilities (44.2), intellectual disabilities, mental health and substance abuse residential facilities (38.5) and nursing care and community care facilities for the elderly (15.7 and 13.1 respectively).

These reported incident rates are likely lower than the actual totals occurring, as studies have shown many patient assaults on healthcare workers go unreported. Reasons given for failure to report incidents of assault include managerial attitudes toward incident reporting, concern the incident would upset or anger loved ones of the patient, a feeling that the aggressive behavior was mitigated by the situation, the impact of the assault was relatively mild or inexperience of the healthcare victim.

The healthcare industry itself is growing substantially in some of the areas which present the most significant risk for workplace assaults. For example, as the baby boomer generation ages, the demand for nursing care and community care facilities for the elderly will continue to increase. According to the Administration for Community Living of the U.S. Department of Health and Human Services, The population 65 and over has increased from 35.5 million in 2002 to 43.1 million in 2012 (a 21% increase) and is projected to more than double to 92 million in 2060. By 2040, there will be about 79.7 million older persons, more than twice their number in 2000. A significantly higher population of older patients needing temporary hospitalization or assisted living or nursing home care may lead to more incidents of assault against a growing pool of healthcare workers.

Several states have passed laws making an assault on a healthcare worker a felony. OSHA publishes guidelines for preventing workplace injuries in the healthcare industry, however, there are no federal requirements and most states do not have provisions for incident reporting or violence prevention training. Healthcare facilities can be proactive. As noted by Ann Gaffey, Sedgwick’s SVP for Healthcare Risk Management, “Workplace violence in all healthcare settings continues to be a top concern for risk managers. These events, including more recent activity seen around the country with active shooters, require attention at all levels of an organization. The enterprise approach to mitigating these risks has never been more critical, with a need to involve all levels of staff in response planning, training, regular drills and debriefing activities. One resource we frequently suggest to our clients is the free Centers for Disease Control and Prevention (CDC) online course for Workplace Violence Prevention for Nurses.”

Healthcare facilities have significant opportunities to develop and implement a workplace violence prevention program. For hospitals accredited by The Joint Commission (TJC), they are surveyed against the standards expected to be met to achieve compliance. One resource offered by TJC is their Sentinel Event Alert, Issue 45: Preventing violence in the health care setting, published in 2010. Additional initiatives to minimize the risk of patient assaults on healthcare workers include (but are certainly not limited to):

  • Avoiding a culture of “violence is just part of the job.” Although patient care can involve a variety of risk factors that can contribute to patients becoming violent – drug or alcohol intoxication, mental or emotional instability, dementia – violence should not be the expectation in the industry.
  • Creating a culture which values reporting of all incidents of assault.
  • Having an active health and safety committee to review incidents of assault and make appropriate recommendations. The committee should include members from management and representation from employees working with patients in various departments.
  • Establishing a violence prevention program including training for new employees and periodic refresher training for existing employees.
  • Developing a comprehensive hazard prevention program. Such a program would need to be specific to the health services provided and the particular facility. The OSHA guidelines provide excellent information for the customization of such a program.
  • Adapting and utilizing a workplace violence program checklist. The OSHA guidelines contain sample documents.

Although the risk of patient assaults on healthcare workers may never be eliminated, implementing the above recommendations and other initiatives should help reduce the incidents of workplace violence in the healthcare industry and reduce the share of work-related injuries represented by assaults.

Joe Daly
Sedgwick
Director Technical Performance

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0063_SDG_150093_Edge03_Images_Article1_e_WEBAs drones gain in popularity, there are a number of ideas and opportunities for them to add value to the insurance industry. They can prove valuable in disaster response efforts, underwriting surveys, claims investigations and in situations where aerial photography is needed. As interest in drones grows throughout the country, there are several challenges for businesses to address. To benefit from this advanced technology, companies will need to define their operational processes, services and usage, while complying with the Federal Aviation Administration (FAA).

FUN FOR HOBBYISTS, VALUABLE FOR BUSINESSES 
With the expanded use of drones on the horizon, the FAA has been updating the rules for flying them. Beginning December 21, 2015, individuals who fly small unmanned aircraft for recreational use will be required to register them with the FAA. Existing owners will have to register by February 19, 2016 and new buyers will have to register before their first flight.1 In addition, the FAA strongly encourages drone operators to follow the safety guidelines below:

1.  Fly below 400 feet and remain clear of surrounding obstacles.

2. Keep the aircraft within visual line of sight at all times.

3. Remain well clear of and do not interfere with manned aircraft operations.

4. Don’t fly within 5 miles of an airport unless you contact the airport control tower before flying.

5. Don’t fly near people or stadiums.

6. Don’t fly an aircraft that weighs more than 55 lbs.

7. Don’t be careless or reckless with your unmanned aircraft – you could be fined for endangering people or other aircraft.2

Flying an unmanned aerial vehicle for any non-hobby or non-recreational purpose requires FAA authorization. For example, using a drone to take aerial photos of your backyard for personal use is recreational, but using it to take photographs to sell is non-recreational. In addition to obtaining approval to fly a drone for commercial use, the operator must have a minimum of a sport pilot certification as well as a spotter who must be able to keep the drone
in their line of sight.3

As state legislatures evaluate how the technology should be regulated, the benefits of their use, the economic impact and privacy concerns are among the key areas being considered.4

In the underwriting and claims investigation arenas, drones provide several key advantages. They can be used in pre-loss valuations to gather images of mechanical/industrial equipment on top of large commercial structures or difficult to navigate places, or to survey crops and land for agricultural exposures. After an event such as a hail storm or hurricane, drones can be used to assess the scope and extent of damage to real property and provide a clearer depiction of the magnitude of the loss. They can take in more information and gather it quicker than adjusters can through the standard process; not just for a single loss location, but also when handling multiple loss locations or large property exposures. For example, if an insurance carrier has a client with losses in areas that were subjected to either wind or flooding due to a hurricane, a drone can be utilized to inspect all of the locations that match specific GPS coordinates and gather images for data collection. This data can then be reviewed, processed and analyzed in conjunction with meteorological data. The technology and capabilities of the drone would increase efficiency and decrease cycle time, leading to quicker payments for policyholders.

Sedgwick was recently approved to use drones and our next steps will include defining the service offering and the operational process. If the FAA continues to require commercial users to have a pilot’s certification or be on private, approved property, it will restrict the application for drone usage in our industry. We will continue developing services that will be integrated with our property liability solutions while monitoring the evolving FAA requirements.

Scott Richardson
SVP, National Property Manager, Vericlaim, a Sedgwick company

Additional Resources
3. FAA Conditions and Limitations. October 2015

This content was originally published in the edge edition 003. To read more articles like this click here http://edge.sedgwick.com/issue-003/

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From Sedgwick Connection: Mary Beth Sanford was honored by Business Insurance as one of their 25 Women to Watch in insurance last week at their annual gala and conference. Mary Beth shares her thoughts on leadership in the following blog and interview.

I truly believe in the servant leadership model.  Leaders must focus on serving their colleagues and senior leaders in order to ensure the ultimate success.  It is your staff of colleagues that actually produces the work so it is critical that you provide them with the support, leadership and guidance so that they can produce exceptional results for clients.  It is important to set expectations, provide resources training and support, remove barriers and hold colleagues accountable to the expectations.

As a leader, you must set a clear vision, ensure you have the right people in the right jobs, be honest and up front, inspire and influence your team, drive for results, measure outcomes, reward positive results, and communicate on a constant basis both formally and informally.

One thing I find very important is to ensure that you are giving regular feedback to your team so that they know where they stand with both what they are doing well and what they need to do to improve.  Given that, we have developed several training development programs for colleagues both interested in management and those that are already in management.  We want to ensure that people have a realistic view of what it takes to perform in a management position and that we are providing the resources to help them get there.

I have always made sure that I never forget what it’s like to sit out in a unit and do the job that we ask our colleagues to perform every day.  I started as a bill review trainee 30 years ago and I still remember how it felt if training programs weren’t effective, if I had computer problems or if I had ideas and solutions and no one wanted to hear them.  I want to make sure that our colleagues always feel like they can provide their feedback and share their good ideas, because it is their collective hard work and input that allow us to be successful.

I also believe that it is important to remember that for your team to shine, a boss must step out of spotlight.  Your job is to ensure that your team gets what they need to succeed and that they enjoy the reward and recognition that comes with success.  If they are growing and developing, then you are doing your job as a manager.

Your actions and behaviors are absolutely critical in a leadership position.  You are a role model and need to carry yourself with the understanding that people are always watching you and how you handle yourself.  You can’t just meet expectations, you have to far exceed them.  You must have the highest level of integrity, be dependable, follow the rules, and deliver on promises.

One of my favorite sayings is by Margaret Thatcher – “Being in power is like being a lady.  If you have to tell people you are, you aren’t.”

Mary Beth Sanford
Senior Vice President, Managing Director
Sedgwick

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ProtectYourBrand2_081915-300x271Whether it is a product recall, cyber attack or customer accident, companies work hard to protect their brands. They want to make sure that everything communicated and shared with their marketplace – customers, employees, investors and media – can stand strong through good and bad times.

Most companies know how they want their brands to be perceived in good times, but how a company reacts in a crisis situation can make or break a reputation. Are you prepared to protect your brand?

If there is a product recall or some sort of brand-related situation, customer service and compassion are the two primary factors – first and foremost. A company’s response must include a risk management element that involves analyzing and funding the losses, but it is vital to ensure the customer has the best possible experience no matter what the situation involves. Having a high-end customer service program that handles problems efficiently for your customers in a way that is compassionate to their needs and concerns can turn a potentially negative situation into a positive brand experience.

ENSURING A POSITIVE CUSTOMER EXPERIENCE

An organization has to show compassion toward the situation when a brand-damaging event occurs, whether they directly caused it or were at the center of an unfortunate accident. By being there for their customers, a company can improve retention and loyalty, reduce the noise on social media, reduce litigation – and ultimately retain that relationship.

A company wants to address individual concerns as quickly as possible to avoid exacerbating the situation with communication delays. If customers feel as though their issues are not being addressed, the potential for litigation can increase. Ten years ago, a product recall or other brand-related event had to make the news before we knew about it. In today’s social media culture, it takes only minutes to gain international attention.

When a product recall occurs, it is important to work with an experienced team that can help put a plan in place, settle the claims promptly and help maintain control of the situation. For example, a food manufacturer dealing with a salmonella incident may want to set up specific criteria and an action plan for each type of claim. To ensure claims are settled properly, this may include gathering details such as whether or not the claimant got sick or went to the hospital. The best claim is a closed claim and the best time to settle a claim of this nature is on the first call. A closed claim with a satisfied customer who feels they were treated fairly won’t become a costly litigated claim.

A WORD ABOUT SOCIAL MEDIA

Social media can enhance a brand, but it can also destroy it. Whether addressing a product recall, cyber attack or customer accident, it all boils down to brand protection vs. brand destruction. It is important to closely monitor social media to see if the event is being mentioned and respond to concerns. Some issues may be out of our control, and individuals may not be happy. The good news is a company can control its response to these individuals and turn it into a positive situation.

Having partners that understand the company message and brand protocols – and treat your brand like their own – can make a difference. At Sedgwick, we advocate for our clients, and their employees and customers every day by doing the right thing. We know that when we help a client, our service quality reflects on them. We are not only acting as an extension of their brand – we are helping them protect it.

I look forward to hearing your thoughts on this topic. You may also want to read my previous blog on social media and risk.

Scott Rogers EVP, Casualty Operations, Sedgwick

* This article was originally published in the edge issue 002

 

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e-NABLE header

As 2015 comes to a close, it’s the perfect time to reflect on how fortunate we are to have industry friends like you. This holiday season, Sedgwick is joining forces with legions of superheroes by partnering with e-NABLE, a global community that matches digital humanitarians who have access to 3-D printers with individuals who have upper limb deficiencies.

The passionate volunteers in e-NABLE’s global network use their own 3-D printers and resources to ensure the devices are provided to recipients free of charge through the Enable Community Foundation. e-NABLE has facilitated the production of more than 1,500 hands since its founding in 2013, primarily for children and military veterans. Learn more about the organization that “makes children smile, parents weep, and nerds rejoice” in this video.

We hope that you will accompany us on our mission by helping us support e-NABLE during the holidays by:

On behalf of all Sedgwick colleagues I wish you and your family a happy and healthy 2016!

Dave North, President and CEO

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This blog article has been republished as originally run in Human Resource Executive magazine’s November 2015 issue

This blog article has been republished as originally run in Human Resource Executive magazine’s November 2015 issue

As we talk with employers around the country, we hear many similar concerns. “Managing leave as an accommodation has become challenging…” “Intermittent leave is a challenge for us…” Does this sound familiar?

When it comes to managing leave and maintaining compliance as it intersects with other benefits – including the Americans with Disabilities Act/ADA Amendments Act (ADA/ADAAA), Family Medical Leave Act (FMLA) and workers’ compensation – the same questions come up again and again. Leave, including intermittent leave, as an accommodation has become much more common since ADAAA took effect in 2009, and compliance challenges will continue to be a hot topic for employers in 2016.

Approach ADA concerns in the spirit of collaboration and think creatively to find accommodations

ADA/ADAAA was designed to protect disabled individuals and aid them in performing the essential functions of a job. An employee does not have to ask for ADA accommodation. If you see an employee impacted by a disabling condition, for example if they have been away under FMLA or a workers’ compensation claim and have difficulty returning to full capacity, it is important to start the interactive process and discuss possible accommodations.

Leave as an accommodation, even on an intermittent basis, is acceptable under ADA/ADAAA provisions and is something many employers explore; however, it may not always be the most reasonable or beneficial option for employer or employee. Scheduling can become a challenge, particularly with intermittent leave. We’re seeing leave used as an extension of FMLA; an employee could potentially be eligible for leave beyond their 12 weeks of federal entitlement. Is leave as an accommodation keeping employees from realizing the benefits of remaining in a productive work environment? What creative solutions may be available to minimize time away from work?

It’s important to remember, even under requirements for reasonable accommodations, an employee must still be able to complete essential job functions and maintain performance levels – lowering standards is not an ADA/ADAAA requirement. Leave as an accommodation may fit within these guidelines; determination should be made based on the job duties of the position and impact on the business. Other options may also be effective that would help the employee return or remain at work – possibly alternative scheduling, telecommuting or changing work locations. Some employers offer job search to help find alternative positions that will accommodate employees if they are no longer able to perform their essential duties.

While legal compliance is of utmost concern, flexibility and advocacy can go a long way toward maintaining employee morale and workplace productivity. Ensure employees are heard, that their input is considered and, ultimately, they know you care about them and want to help.

When considering leave as part of the ADA/ADAAA process, focus on compliance and advocacy

As human resources and risk professionals, it is your responsibility to ensure compliance – for the protection of your workers and your enterprise.

  • Establish consistent procedures that trigger the interactive process.
  • Educate your leaders so they know when to get assistance from ADA resource(s).
  • Review job descriptions to ensure essential functions are detailed – consider whether regular attendance is an essential function.
  • Document within a centralized information management platform – your best means for implementing consistent procedure and also providing a strong defense in case of legal challenges.

Focus on taking care of employees and getting them back to meaningful work and a full life.

  • Educate employees about the ADA/ADAAA process and its intent – most employees don’t understand the differences in ADA, FMLA, STD, LTD; frustration overall can cast a negative light on a process intended for good.
  • Impact return to work and productivity – rather than relying on leave whenever it is suggested as an accommodation, what other solutions can be proposed? Is work from home, even intermittently, an option? Can other workplace modifications be considered?

Where can employers turn for assistance?

Sedgwick has many years of experience ensuring employer ADA/ADAAA compliance for clients. We look at situations from an overall absence management perspective – considering FMLA entitlements, ADA/ADAAA requirements, available return to work options. Our specialists facilitate the interactive process so our clients can focus on making informed, thorough decisions about what accommodations are reasonable for their work environment. We make compliance an integral part of the program.

Even if Sedgwick is not your partner, we offer additional resources for employers, answering many questions that may arise at the intersection of ADA/ADAAA, leave and other benefits. Take a look and contact us for more information.

Stephanie Simpson, SVP, Disability & Absence Management Practice & Compliance

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BHSblogThe idea of identifying and addressing risk factors for addiction as a means of prevention is not groundbreaking; this concept has existed since at least the 1970s. Unfortunately, there has not been much application of this concept to workers’ compensation where injured employees are routinely prescribed powerful and potentially addictive medications. A TED Talk featuring Johann Hari, “Everything you think you know about addiction is wrong,” addressed this  issue by questioning the assumption about addiction as a flaw in character or weakness, which has been historically dealt with by intervention – treating withdrawal, punishing, shaming and threatening the individual. He also questioned the more modern approach to addiction as a disease – addiction is the result of chemicals hijacking the brain. Hari concluded that, in order to prevent and treat addiction, we need to take a more holistic approach – one that understands the strong impact social connections and community involvement has on the individual.

In order to understand addiction, we need to also address various psychosocial stressors and view the whole person at risk for addiction rather than simply treat an addict.

Prevention efforts are more effective in reducing overall addiction rates than intervention efforts, which address an unmet need in workers’ compensation. An integrated managed care approach provides the opportunity to support an injured employee early, toward the goal of identifying risk factors for addiction or a previous history of substance abuse. This may be one key to addressing the costly issue of prescription drug addiction in workers’ compensation. The premise that an “ounce of prevention is work a pound of intervention” is clearly at play.

In addition, according to the National Institute on Drug Abuse (NIDA), the prevalence of addiction risk factors (i.e., poor social skills, limited social network, poverty, ready access to drugs) increases the overall individual risk of substance abuse and addiction. Fortunately, there is significant evidence of the benefit of protective factors such as positive social relationships, community resources and family support that reduce the likelihood of addiction. This comes as no surprise as mentally healthy humans have a need for bonding and companionship, especially during times of duress. A workplace injury and the myriad stressors that occur as a result create significant duress.

Here is an example of a workers’ compensation case where early intervention at the time of injury could elicit a positive outcome by addressing and resolving psychosocial issues:

Barry is a 29 year-old data programmer off from work for the past six months after fracturing his wrist in a “slip and fall” at work. He initially sought treatment a few days post injury when he noticed no improvement in pain or swelling. He underwent two surgeries to repair his wrist, and had two courses of physical therapy. To help with the pain of physical therapy, his surgeon prescribed oxycodone, a narcotic medicine. Barry did not call in a workers’ compensation claim until directed by his HR department, when his company paid short-term disability (STD) expired, and he had not returned to work. As a result of reduced income from STD and subsequent expiration, Barry fell behind on his rent, racked up overwhelming credit card debt and ended up faced with eviction. Prior to his accident, he was very involved socially and active in physical fitness activities including softball, rock climbing and mountain biking. His injury and recovery prevented him from engaging in these activities, and his financial difficulties limited his social activities. As a result, he became isolated in his apartment feeling cut off from others. Over time, he found himself using more of the oxycodone just to cope with the pain – even on days he didn’t have physical therapy.

This case leads us to ponder the major role of risk versus protective factors in predicting the likelihood of addiction. By identifying and addressing the risk factors, and encouraging the protective factors, we can provide support to an injured employee early in the workers’ compensation process. The pain of injury, isolation caused by not being able to engage in meaningful work, financial burdens imposed by being off from work, and the lack of an adequate support network may increase the likelihood of addiction. When addiction does occur, providing a positive yet firm process of making the person whole can yield a much better health outcome than treating a “disease.”

Employers should examine their injured employee population and the “off work” status among them. Why do some employees appear to bounce back quickly from an injury and others do not? Why do some claims appear to drag on longer than what would be considered reasonable? The answer may lie in the prevalence of addiction.

Here at Sedgwick, we take a creative approach to understanding and preventing addiction. In addition to our Complex Pharmacy Management and Nurse Case Management services which focus on the medical issues of addiction, we now offer a Strategic Case Management model that includes, among other things, Behavioral Health Services (BHS). The BHS specialist approaches the injured employee as an individual – a whole person with challenges and strengths, risk factors and protective factors. The BHS specialist acts as an advocate and coach to injured employees during their recovery.

BHS resources, when utilized early in a claim, can help injured employees maintain healthy relationships and make decisions necessary to manage their preexisting stressors and those that occur post injury. At the end of the day, the opposite of addiction is a healthy connection.

What are your thoughts on the best practices for Behavioral Health Services? I look forward to continuing our dialogue on this important topic.

Additional resource: edge magazine, issue 001 – Treating the whole person

Mark Debus, Clinical Behavioral Health Specialist
Sedgwick