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Injury Prevention

Defending Against Cumulative Trauma

Cumulative Trauma, or CT claims, continue to harm workers and drive up costs. Defending against these claims means reducing, through analytics and engineering, the chance that workers get hurt to begin with.
By: | September 12, 2017 • 6 min read

Repetitive motion, or cumulative trauma injuries, stubbornly persist as generators of workers’ compensation claims and productivity losses year after year. Not only do such injuries harm workers, they can even leave them permanently disabled.

Remedies to these injuries do exist, however. Well-established risk management and safety strategies are known to provide effective relief. Additional risk-reduction opportunities exist for employers with those practices already in place, including the adoption of an expanded, macro view of ergonomics; one that considers how work gets done and the engineering of production processes.

Bill Spiers, VP and risk control practice leader, Southeast, Lockton Companies

Wellness programs are also showing early signs of helping mitigate the injuries that typically stem from the constant repetition of the same motion, sometimes over years.

Statistics show that risk mitigation practices have gradually slowed the overall volume of CT claims, along with mitigating a broader category of injuries that the federal Occupational Safety and Health Administration calls “musculoskeletal disorders.”

But several factors continue making repetitive motion injuries — commonly referred to as cumulative trauma claims in California — and musculoskeletal disorders persistent loss drivers.

Today’s younger workers begin taxing their small-muscle groups and motor skills at an early age with the frequent use of modern devices like smartphones and computer tablets. They now show signs of increased strain more typical of an older worker, said Sean McDonald, Workforce Strategies Ergonomics Practice Leader at Marsh Risk Consulting.

Simultaneously, aging workers now have more years of performing very common, repetitive work motions like the twisting, bending and lifting, all of which are known to eventually wear down body parts.

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Employers with their eyes on the bottom line who push for increased production are also taxing worker bodies more than before, especially when safety engineering is not properly considered.

“As production goals keep going up, the impact on the human is not always handled very well. So, you are asking more and more of people and you are outpacing any basic ergonomics with the pace of productivity,” McDonald said.

Bill Spiers, VP and risk control practice leader for the Southeast at Lockton Companies, agrees.

“Because of our effort to try and drive production efficiencies, sometimes we forget and leave out the effects that has on the human body,” Spiers said.

Repetitive stress cases, like OSHA’s broader category of musculoskeletal injuries, often present claims payers with challenges less common than when injury causes are easily witnessed and more obvious, as occurs with broken bones or burns, for example.

OSHA’s definition of musculoskeletal disorders includes upper and lower extremity injuries. The disorders impact the muscles, nerves, ligaments, tendons, and blood vessels with ailments ranging from carpal tunnel syndrome and tendinitis to shoulder and lower-back strains.

Rooting Out the Cause

Because repetitive motion or musculoskeletal injuries often occur over time, their cause is commonly rife with uncertainty. It is challenging to separate out the impacts of aging or harmful activities workers may engage in away from the workplace from legitimate, work-related causes.

About 85 percent of lower-back pain is idiopathic, lacking a specific or known cause, said Wayne Maynard, product director, ergonomics, at Liberty Mutual Risk Control Services. That makes pinpointing a work-related cause challenging and can leave employers paying for ailments they did not contribute to.

The claims are also highly susceptible to manipulation or outright fraud.

California, due to its legal environment, for example, has experienced growth in suspicious, highly-litigated and expensive cumulative-trauma claims filed after workers leave their jobs.

In 2016, the California’s Workers’ Compensation Insurance Rating Bureau reported that cumulative trauma claims, as a percentage of lost-time claims, more than doubled over the past decade. They comprised about 18 percent of the state’s indemnity cases during 2015.

Nationwide, however, there is good news in a Liberty Mutual Safety Index that annually ranks the top 10 causes of serious workplace injuries. It has shown a gradual, long-term decline in the nation’s total spend for cumulative trauma and musculoskeletal-type injuries.

“Because of our effort to try and drive production efficiencies, sometimes we forget and leave out the effects that has on the human body.” — Bill Spiers, VP and risk control practice leader, Southeast, Lockton Companies

Injury prevention programs, ergonomics, return-to-work efforts and the automation of tasks all contribute to the long-term decline.

That is good news because the costs can be steep.

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OSHA reported in 2014 that work-related musculoskeletal disorders account for one of every three dollars spent on workers’ comp. The U.S. Bureau of Labor Statistics estimates they account for 34 percent of all lost workdays.

OSHA’s report states that the disorders cost employers $20 billion annually in direct workers’ comp costs and up to five times that in indirect costs. The injuries also take a personal toll, with workers suffering and unable to work or live full personal lives.

Out-Engineer the Risk

A first line of defense after a cumulative trauma or musculoskeletal claim occurs requires reviewing the injured person’s workplace to learn whether the injury could have been avoided, and what measures will prevent a similar future occurrence, said consultant Barry D. Bloom, managing principal at The bdb Group.

“That is just general good risk management, but it really applies on any injurious exposure that is costly or physically incapacitating because we need as many people as can be to be employed and productive,” Bloom said.

Among other measures for managing a cumulative trauma claim, employers will want to obtain a high-quality, evidence-based medical assessment to help determine whether the injury is work related.

“Because in cumulative trauma, it’s not just that you have been exposed to something,” Bloom explained.

“In other words, it’s not just that you have used a mouse, for example, but you have to also prove that the exposure caused the injury. You can’t do that without a good quality medical assessment.”

Sophisticated employers don’t wait to see a repetitive motion claim before working to prevent them, Bloom added. The range of practices they adopt include evaluating how work is accomplished and what tasks they might automate.

That has led to practices like designing warehouse-type food stores so that workers move entire pallets of products into place with forklifts rather than manually stocking shelves. Other industries have increased the use of robotics.

Barry D. Bloom, managing principal, The bdb Group

Designing processes or engineering in solutions to eliminate risk is now a primary ergonomics practice that has expanded beyond the mere physical workstation adjustments for individual workers that were the focus of earlier ergonomics efforts.

Engineering risk out of jobs and processes, or at least greatly reducing it, is the goal of workplace ergonomics evaluations, McDonald said.

Administrative controls, like job rotations reducing the hours workers are exposed to stressful tasks, also play a role.

“But in our opinion there is no substitute for good design initially and engineering controls after a process has been implemented,” McDonald said.

“Administrative controls would fall last on the hierarchy on how you want to address these things.”

Engineering is critical because you can’t rely on human behavior to consistently perform motions in a safe manner, Spiers added.

“What you never want to do is depend on behavior,” he said.

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Although more outcomes data is necessary, combining safety and ergonomics with wellness programs also shows great potential to mitigate repetitive motion and musculoskeletal claims, Maynard said. That is particularly true with the comorbidities that impact claims severity.

“It’s a tremendous opportunity,” Maynard said

“And there is good data that fitness and overall health have a relationship with musculoskeletal types of disorders.”

Ergonomic assessments are not the only line of defense, Spiers said. Post-offer employment testing also has an important role.

“I laugh because we seem to leave out (employee) selection,” he said.

Making sure that a hire can physically perform the job is an often overlooked, yet obvious line of defense, Spiers said. &

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

More from Risk & Insurance

More from Risk & Insurance

Cyber Resilience

No, Seriously. You Need a Comprehensive Cyber Incident Response Plan Before It’s Too Late.

Awareness of cyber risk is increasing, but some companies may be neglecting to prepare adequate response plans that could save them millions. 
By: | June 1, 2018 • 7 min read

To minimize the financial and reputational damage from a cyber attack, it is absolutely critical that businesses have a cyber incident response plan.

“Sadly, not all yet do,” said David Legassick, head of life sciences, tech and cyber, CNA Hardy.

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In the event of a breach, a company must be able to quickly identify and contain the problem, assess the level of impact, communicate internally and externally, recover where possible any lost data or functionality needed to resume business operations and act quickly to manage potential reputational risk.

This can only be achieved with help from the right external experts and the design and practice of a well-honed internal response.

The first step a company must take, said Legassick, is to understand its cyber exposures through asset identification, classification, risk assessment and protection measures, both technological and human.

According to Raf Sanchez, international breach response manager, Beazley, cyber-response plans should be flexible and applicable to a wide range of incidents, “not just a list of consecutive steps.”

They also should bring together key stakeholders and specify end goals.

Jason J. Hogg, CEO, Aon Cyber Solutions

With bad actors becoming increasingly sophisticated and often acting in groups, attack vectors can hit companies from multiple angles simultaneously, meaning a holistic approach is essential, agreed Jason J. Hogg, CEO, Aon Cyber Solutions.

“Collaboration is key — you have to take silos down and work in a cross-functional manner.”

This means assembling a response team including individuals from IT, legal, operations, risk management, HR, finance and the board — each of whom must be well drilled in their responsibilities in the event of a breach.

“You can’t pick your players on the day of the game,” said Hogg. “Response times are critical, so speed and timing are of the essence. You should also have a very clear communication plan to keep the CEO and board of directors informed of recommended courses of action and timing expectations.”

People on the incident response team must have sufficient technical skills and access to critical third parties to be able to make decisions and move to contain incidents fast. Knowledge of the company’s data and network topology is also key, said Legassick.

“Perhaps most important of all,” he added, “is to capture in detail how, when, where and why an incident occurred so there is a feedback loop that ensures each threat makes the cyber defense stronger.”

Cyber insurance can play a key role by providing a range of experts such as forensic analysts to help manage a cyber breach quickly and effectively (as well as PR and legal help). However, the learning process should begin before a breach occurs.

Practice Makes Perfect

“Any incident response plan is only as strong as the practice that goes into it,” explained Mike Peters, vice president, IT, RIMS — who also conducts stress testing through his firm Sentinel Cyber Defense Advisors.

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Unless companies have an ethical hacker or certified information security officer on board who can conduct sophisticated simulated attacks, Peters recommended they hire third-party experts to test their networks for weaknesses, remediate these issues and retest again for vulnerabilities that haven’t been patched or have newly appeared.

“You need to plan for every type of threat that’s out there,” he added.

Hogg agreed that bringing third parties in to conduct tests brings “fresh thinking, best practice and cross-pollination of learnings from testing plans across a multitude of industries and enterprises.”

“Collaboration is key — you have to take silos down and work in a cross-functional manner.” — Jason J. Hogg, CEO, Aon Cyber Solutions

Legassick added that companies should test their plans at least annually, updating procedures whenever there is a significant change in business activity, technology or location.

“As companies expand, cyber security is not always front of mind, but new operations and territories all expose a company to new risks.”

For smaller companies that might not have the resources or the expertise to develop an internal cyber response plan from whole cloth, some carriers offer their own cyber risk resources online.

Evan Fenaroli, an underwriting product manager with the Philadelphia Insurance Companies (PHLY), said his company hosts an eRiskHub, which gives PHLY clients a place to start looking for cyber event response answers.

That includes access to a pool of attorneys who can guide company executives in creating a plan.

“It’s something at the highest level that needs to be a priority,” Fenaroli said. For those just getting started, Fenaroli provided a checklist for consideration:

  • Purchase cyber insurance, read the policy and understand its notice requirements.
  • Work with an attorney to develop a cyber event response plan that you can customize to your business.
  • Identify stakeholders within the company who will own the plan and its execution.
  • Find outside forensics experts that the company can call in an emergency.
  • Identify a public relations expert who can be called in the case of an event that could be leaked to the press or otherwise become newsworthy.

“When all of these things fall into place, the outcome is far better in that there isn’t a panic,” said Fenaroli, who, like others, recommends the plan be tested at least annually.

Cyber’s Physical Threat

With the digital and physical worlds converging due to the rise of the Internet of Things, Hogg reminded companies: “You can’t just test in the virtual world — testing physical end-point security is critical too.”

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How that testing is communicated to underwriters should also be a key focus, said Rich DePiero, head of cyber, North America, Swiss Re Corporate Solutions.

Don’t just report on what went well; it’s far more believable for an underwriter to hear what didn’t go well, he said.

“If I hear a client say it is perfect and then I look at some of the results of the responses to breaches last year, there is a disconnect. Help us understand what you learned and what you worked out. You want things to fail during these incident response tests, because that is how we learn,” he explained.

“Bringing in these outside firms, detailing what they learned and defining roles and responsibilities in the event of an incident is really the best practice, and we are seeing more and more companies do that.”

Support from the Board

Good cyber protection is built around a combination of process, technology, learning and people. While not every cyber incident needs to be reported to the boardroom, senior management has a key role in creating a culture of planning and risk awareness.

David Legassick, head of life sciences, tech and cyber, CNA Hardy

“Cyber is a boardroom risk. If it is not taken seriously at boardroom level, you are more than likely to suffer a network breach,” Legassick said.

However, getting board buy-in or buy-in from the C-suite is not always easy.

“C-suite executives often put off testing crisis plans as they get in the way of the day job. The irony here is obvious given how disruptive an incident can be,” said Sanchez.

“The C-suite must demonstrate its support for incident response planning and that it expects staff at all levels of the organization to play their part in recovering from serious incidents.”

“What these people need from the board is support,” said Jill Salmon, New York-based vice president, head of cyber/tech/MPL, Berkshire Hathaway Specialty Insurance.

“I don’t know that the information security folks are looking for direction from the board as much as they are looking for support from a resources standpoint and a visibility standpoint.

“They’ve got to be aware of what they need and they need to have the money to be able to build it up to that level,” she said.

Without that support, according to Legassick, failure to empower and encourage the IT team to manage cyber threats holistically through integration with the rest of the organization, particularly risk managers, becomes a common mistake.

He also warned that “blame culture” can prevent staff from escalating problems to management in a timely manner.

Collaboration and Communication

Given that cyber incident response truly is a team effort, it is therefore essential that a culture of collaboration, preparation and practice is embedded from the top down.

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One of the biggest tripping points for companies — and an area that has done the most damage from a reputational perspective — is in how quickly and effectively the company communicates to the public in the aftermath of a cyber event.

Salmon said of all the cyber incident response plans she has seen, the companies that have impressed her most are those that have written mock press releases and rehearsed how they are going to respond to the media in the aftermath of an event.

“We have seen so many companies trip up in that regard,” she said. “There have been examples of companies taking too long and then not explaining why it took them so long. It’s like any other crisis — the way that you are communicating it to the public is really important.” &

Antony Ireland is a London-based financial journalist. He can be reached at [email protected] Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]