White Paper

The Rise of ODG

Official Disability Guideline (ODG), published by Work Loss Data Institute, has now been adopted by Texas, Oklahoma, Kansas, New Mexico, North Dakota, Tennessee, Ohio and Arizona (Arizona for chronic pain and opioids). As ODG continues to gain momentum, it’s hard not to acknowledge its success.

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Official Disability Guideline (ODG), published by Work Loss Data Institute, has now been adopted by Texas, Oklahoma, Kansas, New Mexico, North Dakota, Tennessee, Ohio and Arizona (Arizona for chronic pain and opioids). As ODG continues to gain momentum, it’s hard not to acknowledge its success. In this article I want to share my thoughts on why I think ODG has been on the rise.

While ODG is by no means perfect, and while this article should not be taken as an official endorsement of ODG over all other treatment guidelines, I think UR Nation readers will be interested in hearing my theory on why ODG has been so successful.

ODG is Comprehensive

The ODG guidelines cover an impressive number of conditions and procedures, covering all 10,000 ICD-9 codes, 65,000 ICD-10 codes and 11,000 CPT procedure codes. From my years of practice I’ve seen no reason to dispute their assertion. Because the guidelines are comprehensive, they can help minimize uncertainty and many disputes between medical providers, insurance carriers and managed care entities. I’ve also noticed that because ODG is comprehensive, it rarely needs to be supplemented with other guidelines or resources to cover missing treatments.

ODG is Easy to Navigate

ODG has a user-friendly search feature for body parts and treatment procedures. Each recommendation is linked to the supporting medical evidence, provided in abstract form, which has been ranked, highlighted and indexed. And all treatments are either recommended, not recommended, or questionable. Specifically, the green check boxes mean it’s most likely going to be recommended. A red “X” means it’s probably not recommended. The yellow caution warnings mean the treatment is under study, or is questionable.

ODG is Continuously Updated

Unlike some guidelines that are not updated for several years, ODG reflects new studies as they are conducted and released throughout the year. ODG undergoes a comprehensive annual update process based on scientific medical literature review, claims data analysis and expert panel validation. And I like how the date of the version I’m looking at is always clearly visible. Another thing I’ve noticed is because ODG is frequently updated, ODG will often be the “secondary guide” when the primary guide (like the California Medical Treatment Utilization Schedule or “MTUS”) does not address the procedure in question.

ODG is Independent of Any Specialty Group

ODG tries to represent all medical specialties (occupational medicine, orthopaedic surgery, physical therapy, chiropractic care, etc.). I believe ODG has considerable provider acceptance, including adoption by more states than any other guideline because of its balanced approach focused sharply on improving the health and return-to-work outcomes for injured workers. In other words, unlike medical specialty society guidelines, ODG does not represent the interests of any one provider group over another group.

Conclusion

It will be interesting to see if ODG continues on its current successful trajectory. I know that recently a significant group of ODG supporters pushed the CA DWC to adopt the ODG based formulary; the effort was not successful. We at UR Nation will continue to examine ODG in light of the vast amount of treatment guidelines available and will continue to provide our thoughts and insights.

 

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2017 RIMS

Resilience in Face of Cyber

New cyber model platforms will help insurers better manage aggregation risk within their books of business.
By: | April 26, 2017 • 3 min read

As insurers become increasingly concerned about the aggregation of cyber risk exposures in their portfolios, new tools are being developed to help them better assess and manage those exposures.

One of those tools, a comprehensive cyber risk modeling application for the insurance and reinsurance markets, was announced on April 24 by AIR Worldwide.

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Last year at RIMS, AIR announced the release of the industry’s first open source deterministic cyber risk scenario, subsequently releasing a series of scenarios throughout the year, and offering the service to insurers on a consulting basis.

Its latest release, ARC– Analytics of Risk from Cyber — continues that work by offering the modeling platform for license to insurance clients for internal use rather than on a consulting basis. ARC is separate from AIR’s Touchstone platform, allowing for more flexibility in the rapidly changing cyber environment.

ARC allows insurers to get a better picture of their exposures across an entire book of business, with the help of a comprehensive industry exposure database that combines data from multiple public and commercial sources.

Scott Stransky, assistant vice president and principal scientist, AIR Worldwide

The recent attacks on Dyn and Amazon Web Services (AWS) provide perfect examples of how the ARC platform can be used to enhance the industry’s resilience, said Scott Stransky, assistant vice president and principal scientist for AIR Worldwide.

Stransky noted that insurers don’t necessarily have visibility into which of their insureds use Dyn, Amazon Web Services, Rackspace, or other common internet services providers.

In the Dyn and AWS events, there was little insured loss because the downtime fell largely just under policy waiting periods.

But,” said Stransky, “it got our clients thinking, well it happened for a few hours – could it happen for longer? And what does that do to us if it does? … This is really where our model can be very helpful.”

The purpose of having this model is to make the world more resilient … that’s really the goal.” Scott Stransky, assistant vice president and principal scientist, AIR Worldwide

AIR has run the Dyn incident through its model, with the parameters of a single day of downtime impacting the Fortune 1000. Then it did the same with the AWS event.

When we run Fortune 1000 for Dyn for one day, we get a half a billion dollars of loss,” said Stransky. “Taking it one step further – we’ve run the same exercise for AWS for one day, through the Fortune 1000 only, and the losses are about $3 billion.”

So once you expand it out to millions of businesses, the losses would be much higher,” he added.

The ARC platform allows insurers to assess cyber exposures including “silent cyber,” across the spectrum of business, be it D&O, E&O, general liability or property. There are 18 scenarios that can be modeled, with the capability to adjust variables broadly for a better handle on events of varying severity and scope.

Looking ahead, AIR is taking a closer look at what Stransky calls “silent silent cyber,” the complex indirect and difficult to assess or insure potential impacts of any given cyber event.

Stransky cites the 2014 hack of the National Weather Service website as an example. For several days after the hack, no satellite weather imagery was available to be fed into weather models.

Imagine there was a hurricane happening during the time there was no weather service imagery,” he said. “[So] the models wouldn’t have been as accurate; people wouldn’t have had as much advance warning; they wouldn’t have evacuated as quickly or boarded up their homes.”

It’s possible that the losses would be significantly higher in such a scenario, but there would be no way to quantify how much of it could be attributed to the cyber attack and how much was strictly the result of the hurricane itself.

It’s very, very indirect,” said Stransky, citing the recent hack of the Dallas tornado sirens as another example. Not only did the situation jam up the 911 system, potentially exacerbating any number of crisis events, but such a false alarm could lead to increased losses in the future.

The next time if there’s a real tornado, people make think, ‘Oh, its just some hack,’ ” he said. “So if there’s a real tornado, who knows what’s going to happen.”

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Modeling for “silent silent cyber” remains elusive. But platforms like ARC are a step in the right direction for ensuring the continued health and strength of the insurance industry in the face of the ever-changing specter of cyber exposure.

Because we have this model, insurers are now able to manage the risks better, to be more resilient against cyber attacks, to really understand their portfolios,” said Stransky. “So when it does happen, they’ll be able to respond, they’ll be able to pay out the claims properly, they’ll be prepared.

The purpose of having this model is to make the world more resilient … that’s really the goal.”

Additional stories from RIMS 2017:

Blockchain Pros and Cons

If barriers to implementation are brought down, blockchain offers potential for financial institutions.

Embrace the Internet of Things

Risk managers can use IoT for data analytics and other risk mitigation needs, but connected devices also offer a multitude of exposures.

Feeling Unprepared to Deal With Risks

Damage to brand and reputation ranked as the top risk concern of risk managers throughout the world.

Reviewing Medical Marijuana Claims

Liberty Mutual appears to be the first carrier to create a workflow process for evaluating medical marijuana expense reimbursement requests.

Cyber Threat Will Get More Difficult

Companies should focus on response, resiliency and recovery when it comes to cyber risks.

RIMS Conference Held in Birthplace of Insurance in US

Carriers continue their vital role of helping insureds mitigate risks and promote safety.

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]