Disability

Dealing With The Horrific

More states are offering workers’ comp benefits to first responders suffering from post-traumatic stress.
By: | December 14, 2016 • 7 min read

More and more states are amending their workers’ compensation laws to allow police officers, firefighters and other first responders to file claims for post-traumatic stress disorder triggered by horrific events on the job.

The evidence is scant on how these new laws are impacting both the cost and scope of public sector workers’ comp programs. But virtually everyone agrees that PTSD is a serious issue that departments with first responders must tackle head on.

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Currently, 32 states have laws that permit first responders to file workers’ comp claims for PTSD without accompanying physical claims, and efforts are underway in additional states to similarly amend their workers’ comp laws, according to Norwalk (Conn.) Police Sgt. David Orr.

Orr is president of the Norwalk Police Union, which is lobbying for the State of Connecticut to change its law.

While first responders there can currently file PTSD claims if they witness the death of fellow first responders, there is a push to amend the law so that such claims can be filed after witnessing the death of anyone.

“After Sandy Hook, many of the officers who responded to the school and investigated the aftermath of that devastating tragedy suffered from intense PTSD,” but, he said, “their claims under workers’ comp were rejected by the insurance company and the town.”

“They were forced to go back to work or lose their paychecks, or worse, their jobs. Many did not get the mental health care that they needed.”

In Colorado, unions representing first responders are pushing for changes in that state’s workers’ comp law to delete what they believe is outdated language stating that first responders can only file PTSD claims for traumatic events outside of their usual work experiences, said Longmont (Colo.) Police Sgt. Sean Harper, representing the Colorado Fraternal Order of Police.

Medical Need for PTSD Coverage

Harper said there is medical evidence to support claims that even typical work experiences for first responders can cause extreme distress for some, particularly if the experiences are cumulative.

“As police officers, our job is to protect and serve the community, but we can’t serve at our best if we’re not at our healthiest,” Harper said. “It is in the best interest of the State of Colorado to keep the police as mentally healthy as possible, and that means paying for treatment so these traumatic events do not evolve into PTSD.”

Edie Sonn, vice president, communications and public affairs, Pinnacol

Edie Sonn, vice president, communications and public affairs, Pinnacol

Colorado’s state-chartered workers’ comp carrier Pinnacol Assurance opposed two recent bills in the Colorado legislature, said Edie Sonn, vice president, communications and public affairs.

The Denver-based carrier was concerned about the first bill because it carved out one occupational group, and Pinnacol said the second bill, in the last session, “went too far in the other direction, saying that a claim for mental distress could not be denied based solely on the occupation of the worker.”

“Such a broad approach would create ambiguity in the existing statute and thereby increase litigation,” Sonn said. “We believe there is a middle path between these two extremes to ensure that first responders are covered appropriately.”

Police and firefighter unions in Pennsylvania are also preparing to “push the issue,” said Michael G. Dryden, an attorney at Willig, Williams & Davidson in Philadelphia.

“The laws will make people feel more comfortable getting therapy because their reactions will be treated more as an injury or illness than look like catering to weakness,” Dryden said.

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The cost to workers’ comp programs has yet to be fully measured.

Peter Burton, senior division executive for state relations at National Council on Compensation Insurance in Wayne, Pa., said that many municipalities self-insure for workers’ comp and do not report data to NCCI. Consequently, the organization has little information on claim exposure to price PTSD claims.

“But intuitively, adding this additional compensable injury exposure will likely increase the costs of classifications of municipalities that have first responders, firefighters and EMTs, but not necessarily a significant effect to the entire workers’ compensation system within a particular state,” Burton said.

Workers’ Comp Law Varies

If more states amend their workers’ comp laws, there could be an increase in PTSD claims “due to the apparent availability of an avenue of income without working for those employees so inclined,” said Terri Evans, risk manager for the city of Kingsport, Tenn. and president of the Public Risk Management Association in Alexandria, Va.

Currently, there is no push to change Tennessee’s workers’ comp law.

“In some states, there might be disability benefits and workers’ compensation benefits that would be available to the injured employee at the same time, further enticing disgruntled or unhappy employees,” she said.

Dan Greensweig, assistant director, League of Minnesota Cities, St. Paul, Minn.

Dan Greensweig, assistant director, League of Minnesota Cities, St. Paul, Minn.

“All would depend on how the statute was worded, and what was included or excluded in benefit availability.”

However, Evans stressed that public sector risk managers have a duty to help first responders deal psychologically with traumatic events.

In the City of Kingsport, if an employee feels a work-related incident has impacted them, they can file a claim with the city’s workers’ comp program to determine eligibility of the claim at the onset. That way, even if for some reason the claim is not eligible for workers’ comp, the city can assist the first responder via its employee assistance program, she said.

“We try to be proactive in providing assistance to our employees during times of adversity, whether or not the issue rises to the level of a workers’ compensation claim, because it is important that our employees know they, and their mental and physical health, matter to us,” Evans said.

The Minnesota law that extended workers’ comp coverage for PTSD took effect in October 2013, and so far, the increased cost to public sector workers’ comp programs within the state appears to be “relatively modest” — about 1 percent or so for cities that are members of the League of Minnesota Cities Insurance Trust, said Dan Greensweig, LMCIT’s assistant director at the League of Minnesota Cities in St. Paul, Minn.

The numbers of PTSD claims have been small, about three to five per year, but some of the claims have been very expensive because the individuals needed significant medical care and likely won’t ever be able to return to work as police officers, Greensweig said.

Proactive Counseling

PTSD is “definitely a risk we and our members need to be aware of, not just because of the potential cost implications but also from the standpoint of the public safety officers’ health and well-being,” he said.

“Just as with any other type of injury, the best solution is if we can find ways to prevent the injury in the first place. But of course that’s a challenging thing to do, given the nature of the job for police officers, firefighters, EMTs and other public safety professionals.”

The nonprofit Metro CISM Team in Bloomington, Minn., provides “critical incident stress management teams” throughout the state to help first responders in the aftermath of stressful events, and at least two police departments now require every officer to undergo an annual evaluation that looks for signs of unhealthy levels of stress, Greensweig said.

Ronald F. Meuser, Jr., founder of Meuser Law Office P.A.

Ronald F. Meuser, Jr., founder of Meuser Law Office P.A.

Moreover, LMCIT has paired with Fairview Health Services to offer training to emergency personnel on how to handle situations involving people with mental illness.

“We hope the discussions that result will lead to a greater understanding of mental health issues in general,” he said.

Ronald F. Meuser, Jr., founder of Meuser Law Office P.A. in Eden Prairie, Minn., said that in the hiring process, entities that employ first responders should invest in diagnostic tools such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that will show if someone is suffering from PTSD, depression or anxiety, or indicate whether the person demonstrates a proclivity to developing PTSD in the future.

After first responders experience traumatic events, one-on-one debriefings may be more effective than group debriefings, as first responders may be reluctant to express emotion in front of their co-workers, Meuser said.

First responders should also have yearly psychological check-ups in which they can talk openly and confidentially about any issues, including such taboo issues as recurring nightmares, excessive drinking or moodiness.

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Departments can also be more proactive by looking for changes in a first responder’s demeanor and then referring them for additional help within their EAPs, he said.

For workers who return to work after being involved in violent incidents, risk management programs need to have proactive elements necessary to monitor the workers’ mental recovery, including status check-ins and voluntary counseling services, said Matt Gatewood, a partner at Sutherland Asbill & Brennan LLP in Washington, D.C.

“Achieving the balance of ensuring workers have the necessary means to obtain help while not being too intrusive on the workers’ personal lives is complicated,” Gatewood said. “The most effective programs resist the urge to create a one-size-fits-all approach to this process.” &

Katie Kuehner-Hebert is a freelance writer based in California. She has more than two decades of journalism experience and expertise in financial writing. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Manager Focus

Better Together

Risk managers reveal what they value in their brokers.
By: | June 1, 2017 • 11 min read

Michael K. Sheehan, (left) Managing Director, Marsh and Grant Barkey, Director of Risk Management, Motivate International Inc.

Ask a broker what they can do for you and they will tell you. But let’s ask the risk manager.

What do risk managers really need in a broker? And what do the best brokers do to help risk managers succeed in their jobs?

Chet Porembski, system vice president and deputy general counsel, OhioHealth Corp.

Risk managers say it’s a broker who helps them look knowledgeable and prepared to their bosses. It’s someone who sweeps in like a superhero with an ingenious solution to a difficult problem.

Risk managers want to see brokers bring forth better products year after year. They want a broker who shows up at renewal time with new ideas, not just a rubber stamp.

Great brokers embed with the risk management team and learn everything they can about the company and its leaders. They help risk managers prepare and keep tabs throughout the year on changes at the organization with an eye towards planning the future.

“There’s the broker that sees themselves as just a hired ‘vendor,’ or I should say, somebody that basically just does the job at hand,” said Chet Porembski, system vice president and deputy general counsel at OhioHealth Corp.

“And then there’s the broker that views themselves very much as a business partner.  They truly bring added value to the relationship.”

These brokers look at the tough issues the risk manager is facing and bring in the resources to try to help their client in ways even the client might not have thought about yet. They also do advanced planning that makes the risk manager’s job easier when a problem arises.

“That’s the kind of broker I want.” Porembski said.

And that’s the kind of broker many risk managers need more than ever.

“The only way that the relationship is going to be successful is if you build a tremendous amount of trust.” — Frances Clark, director of risk management and insurance, Sentara Healthcare

That’s because risk managers are under increasing pressure these days. They carry more weight as corporations shrink their departments to cut costs.

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Climate change, cyber threats and geopolitical shifts are turning what were once unthinkable losses into risks that are almost commonplace. And this is all happening in an under-insured risk environment, according a study by PwC entitled Broking 2020: Leading from the Front in a New Era of Risk.

Thankfully there are good brokers out there, risk managers say, who can bring more value to a client today than ever before and help ease that fear.

Brokers — the traditional intermediary in the risk transfer chain — do in fact have a tangible and growing role in developing viable and innovative solutions for the risk manager, according to PwC’s study.

They are the “global risk facilitation leaders.”

“[Whatever] organizations are doing in the short term — be this dealing with market instability or just going about day to-day business — they need to be looking at how to keep pace with the sweeping social, technological, economic, environmental and political (STEEP) developments that are transforming the world,” PwC said in the report.

Advisors That Are Getting It Done

Cyber risks are just one growing challenge that all organizations grapple with.

Frances Clark, director of risk management and insurance at Sentara Healthcare, remembers when her broker first suggested that she hold a leadership tabletop cyber drill.

Clark said her broker kept saying, “I know this is going to be a painful experience, but you are going to come out so much better in the long run.”

Frances Clark, director of risk management and insurance, Sentara Healthcare

Her broker was right, and went so far as to help arrange a system-wide drill that included representatives from the legal, finance, security, communications, marketing and medical teams.

They reviewed the many ways a cyber attack can happen and then practiced a response.

“We benefitted greatly from that exercise,” Clark said.

When Doctors on Demand developed a telemedicine app to offer mental health services through mobile devices, the company ran up against insurance limitations across state lines. All states require that the physician giving the advice be licensed in the same state where the patient is located.

The concern was for patient encounters where the patient actually crossed state boundaries during the encounter, due to the utilization of a mobile phone. The patient may have started with a properly licensed physician in the original state, but then crossed into a neighboring state where the physician was not licensed.

Larry Hansard, a regional managing director at Arthur J. Gallagher & Co., and a 2017 Power Broker®, worked to secure medical professional liability coverage without the traditional licensure exclusions placed on medical professionals by insurance carriers.

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The initiative he helped develop actually changes how health care can be delivered to patients. It allows the emerging telemedicine sector to now offer services around the world.

Two-thirds of the risk managers in the PwC Broker 2020 survey labeled their brokers as “trusted advisors.” But the same survey found that some participants see their broker as more of a straightforward service provider rather than as a source for solutions.

The survey results indicate there is plenty of room for brokers to bring more value to clients.

OhioHealth’s brokers meet each year with OhioHealth’s risk management team to review insurance coverages.  And when the health system holds quarterly risk management retreats, the brokers attend. They bring with them education and insights on a broad range of topics, from property insurance markets to cyber solutions.

Porembski’s brokers also collaborate with the risk managers when there’s an upcoming presentation on risk issues to senior management. Sometimes the brokers help prepare the presentation, he said.

“We end up looking exceptionally good to our senior leaders and our board,” he said.

Involving the broker in interactions with leaders outside the traditional risk management team has benefits beyond selling products, he said. It extends the relationship circle.

Clark tries not to think of her brokers as outside vendors just providing a service. She wants them to be as committed and knowledgeable about the organization as she is.

“The only way that the relationship is going to be successful is if you build a tremendous amount of trust,” Clark said.

“You have to be completely open and honest about everything, no matter how bad it is, or how bad it may look to the market or underwriters.”

“Once you establish that trusting relationship, I think everything else falls into place,” she adds.

Sentara underwent significant growth recently, acquiring five hospitals in about six years. The expansion required a vast amount of integration on insurance programs and a merger of risk management departments and claims.

Clark said her brokers rolled up their sleeves and expertly navigated her through the consolidation.

“I can’t reiterate enough how most risk managers don’t know how to deal with an M&A unless you’ve gone through it.”

She said she wouldn’t have been able to manage the risk of the mergers without her broker’s counsel.

Grading the Broker

Mike Lubben, director of global risk management at Henry Crown & Co. in Chicago, sets standard expectations of his insurance brokers: know the exposures, understand how a risk manager has to sell ideas internally and understand the urgency of requests.

He lets his brokers know his expectations with regular report cards, complete with letter grades. And he isn’t shy about giving out Fs.

  • How did the broker service the EPLI coverage?
  • Did the broker provide expertise and coverage analysis?
  • Was there anything creative?
  • Did the broker recommend new endorsements based on the previous exposure?
  • Did the broker recommend any risk mitigation programs?
  • How well did he communicate and help with presentations?

“A good broker will think this is fantastic,” Lubben said.

This method starts the conversation. It helps Lubben establish long relationships with some stellar brokers.  But if the broker misses the mark, Lubben can have a talk with them about ways to do better in the future. Some brokers he has sent away.

Recently a broker failed on what Lubben calls “blocking and tackling,” the basics like returning phone calls within one day and responding promptly to emails.

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Lubben gave him an “F” on those subjects and told him why. The broker still didn’t improve his game and was eventually replaced.

For many people, insurance can seem very routine from renewal to renewal. But a really good broker will break from routine and come back with some kind of enhancement or improvement.

If the renewal is flat with no change in premium, then Clark says she’ll ask, “What are you going to do for me this year?”

The best brokers are always striving for better, she said.

“Without the brokering community, you would be hard pressed to do your job. I really appreciate what the brokers do, they bring a level of expertise that we can’t possibly have on all lines of coverage.” — Mike Lubben, director of global risk management at Henry Crown & Co.

Motivate International Inc., which operates more than half of the bike share fleets in North America, went through a recent renewal.

Their broker, Marsh, explored more than 10 options with different strategies and programs. In the end, after all of that, they decided the expiring coverage was the best fit.

“Those exercises are very valuable for risk managers,” said Grant Barkey, Motivate’s director of risk management.

“As an innovative company committed to delivering best-in-class services, we believe thorough exploration leads to informed decision-making.”

A good broker understands that a company’s day-to-day operations and a highly effective risk management program have implications for what type of policy should be procured, he said.

Brokers need to partner with risk managers to figure out what those options are, and what the markets are saying and then succinctly relay the information to management.
They also need to have the tact and curiosity to inquire about future plans and figure out what resources might be needed to better serve their client.

When PwC surveyed risk managers, most put their insurance carriers and industry groups ahead of their brokers as the primary source of cyber and supply chain risk solutions; yet these areas are still cited as risk managers’ top concerns.

“Becoming the go-to partners for developing and coordinating innovative and effective solutions in these priority risk areas is at the heart of the commercial opportunity for brokers.” PwC said in its report.

“Yet, our survey suggests that these are important areas where brokers are falling short of the market’s demands and therefore need to adapt.

For example, less than a third of respondents are very satisfied with brokers’ analytical and modelling services across a range of areas.”

When participants were asked how their brokers could be more efficient, respondents put risk analysis at the top of PwC’s survey list. Significantly, more than a third also cited ‘big data’ analysis.

Finding the Right Fit

Paul Kim, Co-CBO of U.S. Retail at Aon Risk Solutions, helps match brokers to risk managers. He keeps in mind that insurance companies tend to sell product, while the clients are looking to manage risks. The right broker assists in mapping risks to existing products and also customizing broad solutions, he said.

“The risk manager’s job has become more complex in the current environment, but there are so many tools available for those individuals to make better informed decisions that truly help protect the overall risk profile of their companies,” Kim said.

Paul Kim, Co-CBO of U.S. Retail, Aon Risk Solutions

That’s why finding the right broker should be first and foremost, he said. Look for an individual with strong industry knowledge, product expertise and market relationships. A strong broker is able to effectively communicate what the risk manager’s goals are to the marketplace to be able to execute and achieve those goals.

“Not every broker can do that,” Kim said.

“Not every broker is the right broker.”

PwC said those brokers who quickly master the art and science of identifying ambiguous threats and then mobilize a broad private/public stakeholder pool to economically manage those risks over time will pull ahead of their competition.

“We’re really generalist,” Lubben said.

“Without the brokering community, you would be hard pressed to do your job. I really appreciate what the brokers do, they bring a level of expertise that we can’t possibly have on all lines of coverage.”

When selecting a broker, the risk manager should also take into account the entire organization behind the broker. Ask about the additional support systems that are available to the broker’s clients.

The company should have a deep bench so when the primary broker is out of the office there’s someone else to rely on who is almost as knowledgeable. The broker organization should also be able to assist you with your budgeting and forecasting from a financial risk perspective.

In PwC’s survey of risk managers, nearly three-quarters want analytics from their broker to help inform their decisionmaking, with concerns over new and emerging risks being a strong driver for this demand.

Clark also thinks it is vitally important for a broker to offer a claims advocate, somebody on the outside, when you are dealing with a carrier on a complicated claim.

“Otherwise you are vulnerable to what the carrier says,” Clark said.

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To lead in this new era of risk, it’s also important that brokers forge close relationships with a broader set of stakeholders that includes governments, academia, specialist risk consultancies and even their industry peers, PwC said in the report.

It’s also going to be important to develop shared databases and research capabilities.

In turn, brokers need to assure this diverse stakeholder group that they are the right party to lead.

Clark, at Sentara Healthcare, said she knows what her risk exposures are today, but she’d like her brokers to anticipate her needs before she does.

“It’s kind of crazy, but amazingly some of them do it,” Clark said.

The broker will also use past experience and industry knowledge to anticipate where policy terms and conditions can be tweaked and improved upon.

“They will, say, advise us that we need to change this policy language, and then a year later you have a claim on that and you thank your lucky stars that they changed it,” Clark said.

“It is amazing to me every time it happens.”  &

Juliann Walsh is a staff writer at Risk & Insurance. She can be reached at [email protected]