Workers’ Compensation: 10 more issues to watch for 2017

Workers’ Compensation: 10 more issues to watch for 2017

The first Out Front Ideas with Kimberly and Mark webinar of 2017 provided our thoughts on the 20 Workers’ Compensation Issues to Watch in 2017.

In early January we discussed what we consider as the first 10 issues that workers’ comp professionals need to be aware of in the coming year. What follows is a summary of the remaining 10 issues we talked about:

11. Impaired workforce

After the November elections, eight states and the District of Columbia allow for recreational use of marijuana. This means around one in five people live in a state where recreational marijuana is now legal.

For employers, this means the reality that a percentage of your workforce is likely impaired. Years ago many employers stopped doing pre-employment drug testing because they couldn’t get enough applicants to pass to fill their jobs. New OSHA regulations from 2016 seek to significantly limit the use of post-injury drug testing, which further inhibits employers looking to maintain a drug-free workplace policy.

Related: Seeing marijuana through the haze of myths

The answers to this issue are challenging. Drug testing for marijuana always focused on whether the drug was present in the system because it was illegal. It can be detected in the system 30 days after use, but showing presence of the drug doesn’t show impairment. This is an area in which the science needs to catch up with social reality. We need an established standard for what constitutes impairment when it comes to marijuana.

12. Alternatives to opioids for chronic pain

For a number of years, there has been significant focus on reducing prescription opioid use in workers’ compensation. With President Obama supporting awareness of the opioid epidemic in 2016, the management of opioids and opioid-related deaths became a household topic across America.

In 2017, we believe there will be greater emphasis on the options outside of opioids for both acute and chronic pain. Admitting patients into functional restoration programs and multi-disciplinary integrated pain management programs have proven successful ways to eliminate opioid use. Meditation, exercise, mindfulness, yoga, and cognitive behavioral therapy have also shown success.

In the quest to offer non-opioid treatment options in workers’ compensation, one of the challenges is coverage. Insurers have been quick to pay for opioids and hesitant to pay for alternative treatments. One-size-fits-all approaches to care will not work for these patients. Treatment is outside of guidelines and requires coordination and care, rather than simply approving or denying treatment. 2017 should be our year to improve functionality for patients currently on opioids, and alternative treatments must be considered.

13. Occupational disease

We know that exposure to certain substances in the workplace can lead to diseases such as cancer. It can take years after the exposure for these diseases to manifest themselves. Yet most statutes only cover certain defined diseases and, in many states, the statute of limitations for reporting a claim is less than the manifestation period for the disease. This creates a hole in the coverage for these diseases.

This is an issue we are going to see in more courts around the nation, as these diseases continue to manifest themselves over time. Medical science is becoming more precise in identifying the sources of these diseases, and, as this happens, workers’ compensation statutes will need to be amended to provide better coverage for those workers who contract such diseases.

The opposite end of the spectrum when it comes to occupational disease coverage are the presumption laws that impact police, firefighters and other first responders. There are currently 34 states with various presumption laws covering a variety of cancers, diseases of the heart and lungs, and certain blood-borne diseases. Opponents of these bills argue that the science does not support an increased risk for disease due to the occupation alone and that these claims should be subject to the same causation standards as other occupational disease claims.

14. Transparency with workers

How many times have you heard an injured worker say they didn’t understand the information that was provided to them? Often injured workers retain attorneys simply because they are confused and don’t feel as though anyone is there to help them. Many of us in the industry believe the pendulum has swung too far toward the process of workers’ compensation instead of taking care of the injured worker.

Related: When a workers’ comp case turns into a minefield of litigation

There was great industry momentum in 2016 with advocacy-based claims models. In 2017, look for ways in which the advocacy discussion evolves into transparency discussions. Transparency is helping the injured worker be a good consumer within the workers’ compensation arena, helping them understand the process, and providing them the best available information to make proper decisions.

15. Insurance talent gap

We know that a significant percentage of the workforce in the insurance industry is expected to retire in the next 10 years. The pipeline of workers to replace these retiring employees is insufficient. To address this, we need a multi-faceted approach that includes working with colleges in developing risk management education and a focus on talent attraction and recruitment.

Related: Solving the aging workforce dilemma

Training programs need to continue to be refined so that the knowledge of retiring employees can be passed on. Finally, employee retention is also a concern. Employers need to be more flexible with working arrangements to compete with other occupations that allow for flexible hours and work-from-home options.

16. Workers’ compensation’s public image

There is growing effort underway to promote the good in our industry. Everyday our companies and our colleagues are making the right decisions and helping people in their time of need. Yet, we also have such a long way to go in the area of public relations.

We need to talk more about the good we do in helping injured workers regain their quality of life. This will not only help with the stakeholders in the system, but will go a long way with recruiting the next generation into our field. Workers’ compensation is about taking care of people and it is meaningful work. Let’s all focus on improving workers’ compensation’s reputation this year.

Related: Return-to-work and local nonprofits: A winning combination

17. The evolution of workers’ compensation

In the last year, several industry groups have had discussions on how workers’ compensation should evolve to better meet the needs of today’s workforce. The threat of federal intervention was the driving force behind much of these discussions. With that threat on hold for now, it is important that the industry take this opportunity to continue these discussions while we can control the agenda.

If change is needed, then we want to be the ones working with legislators and regulators to draft those changes.

18. Machine learning and artificial intelligence

Predictive analytics have been around for more than 10 years. Claims professionals began using predictive analytics to identify the claims that had a propensity for adverse development. Other models evolved to address litigation, sports medicine care opportunities and return-to-work goals. It is safe to say that nearly all payers have predictive models today and probably just as likely that there is little published data on the outcomes associated with these models.

In 2017, we believe the conversation will shift to machine learning. What payers have evolved or are building new claims systems to address artificial intelligence and machine learning? Should all claims be handled by a claims adjuster? Do interventions on every claim impact the ultimate exposure, or are we at a point in the industry where processing a claim should be as easy as a warranty or auto claim? There is tremendous untapped potential in this area.

19. External disruptors

Looking to the future, there are many areas in which external disruptors could have a significant impact on workers’ compensation. We believe this is the biggest issue for the industry to watch in 2017.

Many large employers have been looking at the merits of a 24-hour healthcare model. With medical making up close to 60 percent of workers’ compensation costs, what happens if that element is removed from the system?

Changing retail buying habits are also having an impact on workers’ compensation. Retailers are closing stores and going out of business. With more Americans doing their shopping online, what is the future for the retail industry?

Finally, automation is a reality that has potential to be a significant disruptor. The manufacturing and distribution industry has seen significant job loss due to automation. Think of all the jobs in the trucking, shipping and transportation industry that could be lost to self-driving vehicles. Automation could be the ultimate disruptor for the workers’ compensation industry.

20. Innovation in action

Although the insurance industry is traditionally not known for innovation, we’re certainly hearing more about innovative solutions. Digital health, insurtech, med tech, machine learning, and automation are all terms we are becoming familiar with, and each brings its own value to workers’ compensation.

As the innovations come to fruition in the marketplace, we will be focused on understanding the value of the innovation. Is the innovation going to improve the experience of the user or is it designed for internal processes and workflow? Will the solution drive efficiency and speed to decision or process improvements? How will quality, compliance and outcomes be impacted and measured?

Related: Embrace the shift! Transforming the insurance industry from the outside-in

Kimberly George is the senior vice president, senior healthcare advisor at Sedgwick. She can be reached at  

Mark Walls is the vice president, communications and strategic analysis, at Safety National. He can be reached at

To listen to the complete webinar, visit Out Front Ideas with Kimberly and Mark.

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