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The Risks of Sitting

Desk Job Dangers

Programs to decrease prolonged sitting during the day could reduce workers' comp claims.
By: | January 27, 2014 • 6 min read

When we think about dangerous working conditions and risk management, our thoughts are most likely drawn to construction sites, asbestos removal, dealing with nuclear waste, or fishing in the Bering Sea. For the owners of companies and corporations that do this kind of work, managing the risk inherent in the job is essential to having a successful and profitable business.

But the majority of Americans do not work in those traditionally dangerous jobs. In fact, 86 percent of all Americans today work in some type of office setting, where they sit at a desk for up to 40 hours a week.

People in these jobs typically feel very safe at work. If you asked them the most dangerous or hazardous part of their day, they would probably say their commute to work — not something that happens within the safe four walls of their office. However, over the last few years, research has shown us that simply sitting at a desk is one of the most hazardous things a person can do to his or her body.

As a chiropractor, I have seen firsthand the ravaging effects prolonged sitting has on people’s bodies. The majority of my patients today are suffering from some form of a repetitive strain injury. Most of the neck, back, and wrist pain we see in this country today is likely a result of prolonged sitting.

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We know that musculoskeletal strains are the No. 1 and fastest growing class of workers’ compensation injury, and that is despite the fact that the numbers are still widely underreported. The true impact that a sedentary work style has on our bodies and our bottom line has yet to be seen.

But they are ways to mitigate the risks associated with what used to be thought of as sunny desk jobs.

What Happens to My Body When I Sit?

Repetitive Strain Injuries, or RSIs, occur when the body suffers repeated micro-traumas due to undue force or strain on the musculoskeletal system. Sitting for too long with poor posture is the most common cause. And unfortunately, treatment for RSIs is complicated for several reasons:

• Those affected do not always know the source of their pain, and diagnosis can take months or even years. This causes escalating expense and time lost from work.

• Once an injury is treated, the worker often goes right back to the behavior that created the injury in the first place.

• These injuries take years to develop, and often years to rehabilitate.

Because the number of RSIs of the neck and back are underreported, I often tell employers to look at the number of carpal tunnel claims they have. If that number is high, it is very likely that their workers are also suffering from an assortment of other injuries as well.

Another risk for employees who sit for long hours each week is deconditioning syndrome — even when the worker’s posture is perfect and ergonomic devices are being used.

Bodies are made to move. And without movement, the musculoskeletal system gets weak and stiff. The danger of deconditioning syndrome is that an unfit body is more likely to be injured doing a simple task such as gardening or playing tennis.

If your company has a large number of lower back pain/injury claims in your workers’ compensation or disability funnel, deconditioning syndrome may be to blame.  Not only does this condition make it much more likely for an employee to suffer an injury, but it also makes rehabilitation of that injury a much longer more arduous process. A healthy and fit body heals much quicker.

Obesity and chronic diseases, such as heart disease, diabetes and cancer, are also associated with prolonged sitting. Not only are these diseases dangerous and costly in their own right, but those who are chronically sick have a much harder time recovering from injuries. Obese people in particular are more likely to be injured and to lose more time from work once an injury occurs.

The costs of injuries and diseases related to long hours sitting are difficult to quantify. Some reports have calculated the cost at billions of dollars a year in workers’ compensation and disability claims, but that number is only a portion of the full amount companies are spending on injured office employees.

Like other jobs that have an inherent risk for their workers, steps must be taken to protect office workers from the dangers of their jobs and corporations from footing the bill.

What Do We Do About It?

Just like a construction company gives out hard hats to their workers, or a doctor wears latex gloves, there are simple things we can offer employers to keep their employees safe from the dangers of prolonged sitting.

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Managing the risks associated with prolonged sitting has two necessary elements: education and prevention.

One of the biggest problems associated with prolonged sitting injuries is their misdiagnosis. Once a person is afflicted with a repetitive strain injury, a company can cut down on the costs associated with treatment if a proper diagnosis is reached quickly.

Often injured workers submit to unnecessary and expensive diagnostic testing like MRI, X-ray, and EMGs, and are prescribed a myriad of medications, including heavy duty pain killers.

If a worker is suffering from an RSI, they should seek help from a chiropractor, masseuse, or physical therapist, along with seeing their primary care physician for short term anti-inflammatory therapy.

To prevent injuries, employers must consider ways to reduce exposure to the risk. Quite simply, have them sit less. There are many options for employers today, including ergonomic devices, standing desks, other alternative workstations, and my personal recommendation, a micro-break system.

Micro-break systems get people moving once an hour, reducing their sitting time while increasing their overall productivity and energy levels. Implementing one of these systems reduces your exposure to the risk of prolonged sitting for years to come.

For many years now, employers have been trying to mitigate the costs associated with sedentary workers through wellness programs, but nearly all such programs look to individual behaviors as the cause of these conditions.

Recognizing that many injuries and illnesses afflicting workers today are a result of the job itself offers employers an opportunity to apply a risk management model to reducing health care costs. Such a model may be more successful at creating a lasting change because they change the job, not the person doing it.

The timing couldn’t be better. With the constant rise in health care costs, the crippling number of Americans addicted to prescription pain killers, and the growing burden on employers to create healthier work environments, employers need to enact change and gain control over rising costs.

Addressing the hazards of the modern American workplace — where the very chair employees sit in poses significant long-term health risks — is a win-win for everyone.

Gregory Soltanoff, D.C., is a musculoskeletal and workplace injury specialist and creator of Voom, a micro-break corporate wellness program. He can be reached at [email protected]

Pharma Under Fire

Opioids Give Rise to Liability Epidemic

Opioids were supposed to help. Instead, their addictive power harmed many, and calls for accountability are broadening.
By: | May 1, 2018 • 8 min read

The opioid epidemic devastated families and flattened entire communities.

The Yale School of Medicine estimates that deaths are nearly doubling annually: “Between 2015 and 2016, drug overdose deaths went from 33,095 to 59,000, the largest annual jump ever recorded in the United States. That number is expected to continue unabated for the next   several years.”

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That’s roughly 160 deaths every day — and it’s a count that’s increasing daily.

In addition to deaths, the number of Americans struggling with an opioid disorder disease (the official name for opioid addiction) is staggering.

The National Institute on Drug Abuse (NIDA) estimates that 2 million people in the United States suffer from substance use disorders related to prescription opioid pain relievers, and roughly one-third of those people will “graduate” to heroin addiction.

Conversely, 80 percent of heroin addicts became addicted to opioids after being prescribed opioids.

As if the human toll wasn’t devastating enough, NIDA estimates that addiction costs reach “$78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.”

Shep Tapasak, managing principal, Integro Insurance Brokers

With numbers like that, families are not the only ones left picking up the pieces. Municipalities, states, and the federal government are strained with heavy demand for social services and crushing expenditures related to opioid addiction.

Despite the amount of money being spent, services are inadequate and too short in duration. Wait times are so long that some people literally die waiting.

Public sector leaders saw firsthand the range and potency of the epidemic, and were among the first to seek a legal reckoning with the manufacturers of  synthetic painkillers.

Seeking redress for their financial burden, some municipalities, states and the federal government filed lawsuits against big pharmaceutical companies and manufacturers. To date, there are more than 100 lawsuits on court dockets.

States such as Ohio, West Virginia, New Jersey, Pennsylvania and Arkansas have been hit hard by the epidemic. In Arkansas alone, 72 counties, 15 cities, and the state filed suit, naming 65 defendants. In Pennsylvania, 16 counties, Philadelphia, and Commonwealth officials have filed lawsuits.

Forty one states also have banded together to subpoena information from some drug manufacturers.

Pennsylvania’s Attorney General, Josh Shapiro, recently told reporters that the banded effort seeks to “change corporate behavior, so that the industry can no longer do what I think it’s been doing, which is turning a blind eye to the effects of dumping these drugs in the communities.”

The volume of legal actions is growing, and some of the Federal cases have been bound together in what is called multidistrict litigation (MDL). These cases will be heard by a judge in Ohio. Plaintiffs hope for a settlement that will provide funding to be used to help thwart the opioid epidemic.

“From a societal perspective, this is obviously a big and impactful issue,”  said Jim George,  a managing director and global claims head with Swiss Re Corporate Solutions. “A lot of people are suffering in connection with this, and it won’t go away anytime soon.

“Insurance, especially those in liability, will be addressing this for a long time. This has been building over five or six years, and we are just now seeing the beginning stages of liability suits.” 

Basis for Lawsuits

The lawsuits filed to date are based on allegations concerning: What pharma knew or didn’t know; what it should have known; failure to monitor size and frequency of opioid orders, misrepresentation in marketing about the addictive nature of opioids; and false financial disclosures.

Opioid manufacturers, distributors and large drugstore chains together represent a $13 billion-a-year industry, meaning the stakes are high, and the pockets deep. Many have compared these lawsuits to the tobacco suits of the ’90s.

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But even that comparison may pale. As difficult as it is to quit smoking, that process is less arduous than the excruciating and often impossible-to-overcome opioid addiction.

Francis Collins, a physician-geneticist who heads the National Institutes of Health, said in a recorded session with the Washington Post: “One really needs to understand the diabolical way that this particular set of compounds rewires the brain in order to appreciate how those who become addicted really are in a circumstance where they can no more [by their own free will] get rid of the addiction than they can get free of needing to eat or drink.”

“Pharma and its supply chain need to know that this is here now. It’s not emerging, it’s here, and it’s being tried. It is a present risk.” — Nancy Bewlay, global chief underwriting officer for casualty, XL Catlin

The addiction creates an absolutely compelling drive that will cause people to do things against any measure of good judgment, said Collins, but the need to do them is “overwhelming.”

Documented knowledge of that chemistry could be devastating to insureds.

“It’s about what big pharma knew — or should have known.  A key allegation is that opioids were aggressively marketed as the clear answer or miracle cure for pain,” said Shep Tapasak, managing principal, Integro Insurance Brokers.

These cases, Tapasak said, have the potential to be severe. “This type of litigation boils down to a “profits over people” strategy, which historically has resonated with juries.”

Broadening Liability

As suits progress, all sides will be waiting and watching to see what case law stems from them. In the meantime, insurance watchers are predicting that the scope of these suits will broaden to include other players in the supply chain including manufacturers, distribution services, retail pharmacies, hospitals, physician practices, clinics, clinical laboratories and marketing agencies.

Litigation is, to some extent, about who can pay. In these cases, there are several places along the distribution chain where plaintiffs will seek relief.

Nancy Bewlay, global chief underwriting officer for casualty, XL Catlin

Nancy Bewlay, XL Catlin’s global chief underwriting officer for casualty, said that insurers and their insureds need to pay close attention to this trend.

“Pharma and its supply chain need to know that this is here now. It’s not emerging, it’s here, and it’s being tried. It is a present risk,” she said.

“We, as insurers who identify emerging risks, have to communicate to clients. We like to be on the forefront and, if we can, positively influence the outcome for our clients in terms of getting ahead of their risks.”

In addition to all aspects of the distribution chain, plaintiffs could launch suits against directors and officers based on allegations that they are ultimately responsible for what the company knew or should have known, or that they misrepresented their products or signed off on misleading financial statements.

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Shareholders, too, could take aim at directors and officers for loss of profits or misleading statements related to litigation.

Civil litigation could pave the way, in some specific instances, for criminal charges. Mississippi Attorney General Jim Hood, who in 2015 became the first state attorney general to file suit against a prescription drug maker, has been quoted as saying that if evidence in civil suits points to criminal behavior, he won’t hesitate to file those charges as well.

Governing, a publication for municipalities and states, quoted Hood in late 2017 as saying, “If we get into those emails, and executives are in the chain knowing what they’ve unleashed on the American public, I’m going to kick it over to a criminal lawsuit. I’ve been to too many funerals.”

Insurers and insureds can act now to get ahead of this rising wave of liability.

It may be appropriate to conduct a review of policy underwriting and pricing. XL Catlin’s Bewlay said, “We are not writing as if everyone is a pharma manufacturer. Our perception of what is happening is that everyone is being held accountable as if they are the manufacturer.

“The reality is that when insurers look at the pharma industry and each part of the supply chain, including the pharma companies, those in the chain of distribution, transportation, sales, marketing and retail, there are different considerations and different liabilities for each. This could change the underwriting and affect pricing.”

Bewlay also suggests focusing on communications between claims teams and underwriters and keeping a strong line of communication open with insureds, too.

“We are here to partner with insureds, and we talk to them and advise them about this crisis. We encourage them to talk about it with their risk managers.”

Tapasak from Integro encourages insureds to educate themselves and be a part of the solution. “The laws are evolving,” he said. “Make absolutely certain you know your respective state laws. It’s not enough to know about the crisis, you must know the trends. Be part of the solution and get as much education as possible.

“Most states have ASHRM chapters that are helping their members to stay current on both passed and pending legislation. Health care facilities and providers want to do the right thing and get educated. And at the same time, there will likely be an uptick in frivolous claims, so it’s important to defend the claims that are defensible.”

Social Service Risk

In addition to supply chain concerns, insurers and insureds are concerned that even those whose mission it is to help could be at risk.

Hailed as a lifesaver, and approved by the Food and Drug Administration (FDA), the drug Naloxone, can be administered to someone who is overdosing on opioids.  Naloxone prevents overdose by blocking opioid receptor sites and reversing the effects of the overdose.

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Some industry experts are concerned that police and emergency responders could incur liability after administering Naloxone.

But according to the U.S. Department of Justice, “From a legal standpoint, it would be extremely difficult to win a lawsuit against an officer who administers Naloxone in good faith and in the course of employment. … Such immunity applies to … other professional responders.”

Especially hard hit are foster care agencies, both by increased child placements and stretched budgets. More details in our related coverage.

While the number of suits is growing and their aim broadening, experts think that some good will come of the litigation. Settlements will fund services for the addicted and opioid risk awareness is higher than ever. &

Mercedes Ott is managing editor of Risk & Insurance. She can be reached at [email protected]