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CTE: What Lies Ahead for Workers’ Comp?

As CTE increasingly becomes an emerging issue for other professions, workers' comp stakeholders should start thinking about how to prepare for future CTE claims.
By: | November 1, 2017 • 5 min read

The summer of 2017 saw the first claims paid out to retired NFL players from the $1 billion settlement fund created in the wake of the class-action lawsuit brought by former athletes against the league. In the suit, retired players alleged that the NFL covered up evidence of the damaging neurological effects caused by repeated hits to the head.

At the root of that neurological damage lies Chronic Traumatic Encephalopathy, or CTE.

CTE may cause a host of cognitive and behavioral problems, including depression, aggression and violence, paranoia and impulse control, impaired judgment, confusion, progressive dementia, Parkinson’s and Alzheimer’s disease.

But those symptoms may not manifest until someone reaches their 40s or 50s. The brain damage can begin decades earlier and builds over time through repeated sub-concussive hits to the head. The type that linemen can sustain dozens of times within a single game.

Linking the symptoms to CTE is difficult, though, because the condition currently can only be diagnosed after death.

The NFL controversy might have swiveled the spotlight onto CTE and raised public awareness, but it has also raised questions and concerns in other industries. There’s no telling how many other professions are at risk of sustaining head trauma and developing the disease.

“As we learn more about CTE, it opens the door to other types of professions where it’s not an emerging issue yet because they are not as high-profile as professional sports,” said Danielle Jaffee, Manager of Government Affairs, IWP.

As research sheds more light on this neurodegenerative disease, proactive discussions about the risk of CTE can help the workers’ comp industry stay ahead of the curve.

Researchers Take on CTE

Danielle Jaffee, Manager of Government Affairs

The NFL settlement compensates former players experiencing CTE symptoms for medical testing and further care, but freed the NFL from admitting fault or disclosing what it knew and when about the link between repetitive head trauma and CTE.

But others are quickly filling in the gaps.

Boston University’s CTE Center has identified markers in brain tissue that indicate CTE, and researchers are moving toward the goal of developing a method to diagnose CTE in living people, as well as potential treatments. It draws on a bank of 425 donated brains, 270 of which have been diagnosed with CTE.

Other entities like the Brain Injury Research Institute and Stanford University are also studying ways to identify CTE in a living brain, and what sources and types of trauma may lead to degeneration of brain tissue.

But they remain a long way off from understanding how to diagnose or effectively treat the condition.

Workers’ Comp Implications

“We don’t yet have a test in place that could indicate if a living person has CTE,” said Jaffee. “And you can’t have a workers’ comp claim without a diagnosis. So while CTE hasn’t impacted our industry yet, it certainly has the potential to do so.”

The NFL lawsuit could provide a rough blueprint for how claims may be handled in the future, but challenges emerge in variations among states’ classification of professional athletes.

Many states bar professional athletes from filing workers’ comp claims or set caps on payout amounts, so claims filed in the NFL settlement won’t translate directly to a workers’ comp scenario.

“There are states like Kansas that define professional athletes as employees, but other states like Florida specifically exclude them. And then there are states that defer to labor union contracts,” Jaffee said. “If there were less restrictions on professional athletes, you might have greater likelihood of them filing claims.”

Thirty-eight former players involved in the NFL lawsuit did opt out of the settlement, preferring to pursue their own claims individually in state court.

“They’re trying to force the NFL to cover CTE as a workers’ comp claim, but the court system is slow and we haven’t seen yet how that will play out,” Jaffee said.

Even if the courts allow athletes to file a works’ comp claim, it’s uncertain whether they’ll recognize CTE as a compensable injury due to its cumulative nature. State laws again vary in whether cumulative trauma qualifies as a workers’ comp injury, and claimants will bear the burden of proving a direct link between their symptoms and their tenure as pro football players.

Despite these challenges, “I think a professional athlete making a workers’ comp claim for CTE is how we’re going to figure out how it works – if it works – and how we should respond as an industry,” Jaffee said.

Getting the Conversation Going

In the face of so many unanswered questions, how can stakeholders in the workers’ comp industry prepare for future CTE claims?

“At IWP, our goal is start a conversation around this topic with all stakeholders: the insurers who would cover claims, the PBMs that would handle the medications, the pharmacies and doctors treating the injury, and the legislators and policymakers crafting state law. Even the lawyers who could represent claimants, whether they are professional athletes or not,” Jaffee said.

“We’re trying to stay on top of things that will impact our industry and make sure that these discussions are happening now so that no one is caught off guard.”

It will take time for further research to illuminate the details of how CTE develops and progresses, and what could be done to treat the disease before it’s too late. But there is enough understanding to drive preventative measures and find ways to reduce repeated head trauma.

Even the NFL has encouraged safer tackling techniques and flag football as an alternative for younger players.

CTE might not have an impact on worker’s comp in the next year or even five years, but planning ahead will yield less confusion and better outcomes for providers, payers and claimants alike.

“Through these conversations, and as we learn more about CTE, we’ll be looking at our workers’ comp systems and questioning if those systems are the best avenue to handle these claims. And if not, do we need to figure out a better way?” Jaffee said.

“We’re here to start and facilitate that conversation so that states can effectively serve their communities in this area as it emerges.”

To learn more, visit https://www.iwpharmacy.com/.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with IWP. The editorial staff of Risk & Insurance had no role in its preparation.




IWP is a national home delivery pharmacy service working as an advocate for injured individuals. Fully licensed in 48 states, IWP enhances patient access and alleviates administrative and financial burdens.

Property

Insurers Take to the Skies

This year’s hurricane season sees the use of drones and other aerial intelligence gathering systems as insurers seek to estimate claims costs.
By: | November 1, 2017 • 6 min read

For Southern communities, current recovery efforts in the wake of Hurricane Harvey will recall the painful devastation of 2005, when Katrina and Wilma struck. But those who look skyward will notice one conspicuous difference this time around: drones.

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Much has changed since Katrina and Wilma, both economically and technologically. The insurance industry evolved as well. Drones and other visual intelligence systems (VIS) are set to play an increasing role in loss assessment, claims handling and underwriting.

Farmers Insurance, which announced in August it launched a fleet of drones to enhance weather-related property damage claim assessment, confirmed it deployed its fleet in the aftermath of Harvey.

“The pent-up demand for drones, particularly from a claims-processing standpoint, has been accumulating for almost two years now,” said George Mathew, CEO of Kespry, Farmers’ drone and aerial intelligence platform provider partner.

“The current wind and hail damage season that we are entering is when many of the insurance carriers are switching from proof of concept work to full production rollout.”

 According to Mathew, Farmers’ fleet focused on wind damage in and around Corpus Christi, Texas, at the time of this writing. “Additional work is already underway in the greater Houston area and will expand in the coming weeks and months,” he added.

No doubt other carriers have fleets in the air. AIG, for example, occupied the forefront of VIS since winning its drone operation license in 2015. It deployed drones to inspections sites in the U.S. and abroad, including stadiums, hotels, office buildings, private homes, construction sites and energy plants.

Claims Response

At present, insurers are primarily using VIS for CAT loss assessment. After a catastrophe, access is often prohibited or impossible. Drones allow access for assessing damage over potentially vast areas in a more cost-effective and time-sensitive manner than sending human inspectors with clipboards and cameras.

“Drones improve risk analysis by providing a more efficient alternative to capturing aerial photos from a sky-view. They allow insurers to rapidly assess the scope of damages and provide access that may not otherwise be available,” explained Chris Luck, national practice leader of Advocacy at JLT Specialty USA.

“The pent-up demand for drones, particularly from a claims-processing standpoint, has been accumulating for almost two years now.” — George Mathew, CEO, Kespry

“In our experience, competitive advantage is gained mostly by claims departments and third-party administrators. Having the capability to provide exact measurements and details from photos taken by drones allows insurers to expedite the claim processing time,” he added.

Indeed, as tech becomes more disruptive, insurers will increasingly seek to take advantage of VIS technologies to help them provide faster, more accurate and more efficient insurance solutions.

Duncan Ellis, U.S. property practice leader, Marsh

One way Farmers is differentiating its drone program is by employing its own FAA-licensed drone operators, who are also Farmers-trained claim representatives.

Keith Daly, E.V.P. and chief claims officer for Farmers Insurance, said when launching the program that this sets Farmers apart from most carriers, who typically engage third-party drone pilots to conduct evaluations.

“In the end, it’s all about the experience for the policyholder who has their claim adjudicated in the most expeditious manner possible,” said Mathew.

“The technology should simply work and just melt away into the background. That’s why we don’t just focus on building an industrial-grade drone, but a complete aerial intelligence platform for — in this case — claims management.”

Insurance Applications

Duncan Ellis, U.S. property practice leader at Marsh, believes that, while currently employed primarily to assess catastrophic damage, VIS will increasingly be employed to inspect standard property damage claims.

However, he admitted that at this stage they are better at identifying binary factors such as the area affected by a peril rather than complex assessments, since VIS cannot look inside structures nor assess their structural integrity.

“If a chemical plant suffers an explosion, it might be difficult to say whether the plant is fully or partially out of operation, for example, which would affect a business interruption claim dramatically.

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“But for simpler assessments, such as identifying how many houses or industrial units have been destroyed by a tornado, or how many rental cars in a lot have suffered hail damage from a storm, a VIS drone could do this easily, and the insurer can calculate its estimated losses from there,” he said.

In addition,VIS possess powerful applications for pre-loss risk assessment and underwriting. The high-end drones used by insurers can capture not just visual images, but mapping heat, moisture or 3D topography, among other variables.

This has clear applications in the assessment and completion of claims, but also in potentially mitigating risk before an event happens, and pricing insurance accordingly.

“VIS and drones will play an increasing underwriting support role as they can help underwriters get a better idea of the risk — a picture tells a thousand words and is so much better than a report,” said Ellis.

VIS images allow underwriters to see risks in real time, and to visually spot risk factors that could get overlooked using traditional checks or even mature visual technologies like satellites. For example, VIS could map thermal hotspots that could signal danger or poor maintenance at a chemical plant.

Chris Luck, national practice leader of Advocacy, JLT Specialty USA

“Risk and underwriting are very natural adjacencies, especially when high risk/high value policies are being underwritten,” said Mathew.

“We are in a transformational moment in insurance where claims processing, risk management and underwriting can be reimagined with entirely new sources of data. The drone just happens to be one of most compelling of those sources.”

Ellis added that drones also could be employed to monitor supplies in the marine, agriculture or oil sectors, for example, to ensure shipments, inventories and supply chains are running uninterrupted.

“However, we’re still mainly seeing insurers using VIS drones for loss assessment and estimates, and it’s not even clear how extensively they are using drones for that purpose at this point,” he noted.

“Insurers are experimenting with this technology, but given that some of the laws around drone use are still developing and restrictions are often placed on using drones [after] a CAT event, the extent to which VIS is being used is not made overly public.”

Drone inspections could raise liability risks of their own, particularly if undertaken in busy spaces in which they could cause human injury.

Privacy issues also are a potential stumbling block, so insurers are dipping their toes into the water carefully.

Risk Improvement

There is no doubt, however, that VIS use will increase among insurers.

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“Although our clients do not have tremendous experience utilizing drones, this technology is beneficial in many ways, from providing security monitoring of their perimeter to loss control inspections of areas that would otherwise require more costly inspections using heavy equipment or climbers,” said Luck.

In other words, drones could help insurance buyers spot weaknesses, mitigate risk and ultimately win more favorable coverage from their insurers.

“Some risks will see pricing and coverage improvements because the information and data provided by drones will put underwriters at ease and reduce uncertainty,” said Ellis.

The flip-side, he noted, is that there will be fewer places to hide for companies with poor risk management that may have been benefiting from underwriters not being able to access the full picture.

Either way, drones will increasingly help insurers differentiate good risks from bad. In time, they may also help insurance buyers differentiate between carriers, too. &

Antony Ireland is a London-based financial journalist. He can be reached at [email protected]