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Treating Injuries without Employer Pain: Managing the Challenges of Opioids and Marijuana

Liberty Mutual's claims management framework can help businesses tackle challenges as they come, including medical marijuana.
By: | July 27, 2017 • 5 min read

Most employees have peace of mind that while a workplace injury may cause pain or disrupt their lives, they’ll be treated as quickly and effectively as possible through their employers’ workers’ compensation programs. Employees also know that they’ll have treatment options that best fit their conditions and medical needs. Two potential treatments, however, present unique challenges for employers: opioids and medical marijuana.

Updated medical guidelines, new laws, and cultural shifts have driven the rise of these two classes of drugs as potential forms of treatment in workers’ compensation cases. While opioids and medical marijuana are in very different stages as treatment methods, complications exist that could put employees and businesses at risk if not managed effectively. Their potential impacts mean employers need to have a forward-thinking claims framework in place to help keep employees safe and minimize risk.

The Rise of Opioids in Workers’ Comp

Doctors and nurses must ask patients to rate their pain on a scale of one to 10, and treat it accordingly. That subjectivity, in part, has given rise to the over-prescription of opioids. “Historically, opioids were used appropriately to alleviate pain associated with cancer and similar severe pain conditions. Over time, physicians prescribed opioids for far less severe pain conditions. The resulting rise in availability has also contributed to the current epidemic in the United States,” said Maureen McCarthy, SVP and Manager, Workers’ Comp Field Claims, Liberty Mutual Insurance.

The Centers for Disease Control and Prevention (CDC) estimate that nearly half of all U.S. opioid overdose deaths involve prescription opioids – in 2015, there were 15,000 prescription-related opioid deaths1.

Its impact is also being felt in the workers’ comp space. Seventy percent of injured workers take some form of an opioid painkiller – and workers’ comp claims involving opioids cost, on average, $20,000 more than claims without2.

A Flexible Framework for Evolving Claims

Opioids aren’t the only change impacting workers’ comp; emerging treatments like medical marijuana are also on the rise. Liberty Mutual Insurance built a flexible claims management framework to address evolving treatment methods.

The framework’s foundation is in Liberty Mutual’s deep industry knowledge and engagement with experts and institutions. For example, when the CDC was drafting national guidelines to help doctors prescribe opioids appropriately, Liberty Mutual’s regional medical directors provided feedback during the comment period.

“There were two things in the initial draft that were concerning to us. One was the lack of emphasis on functionality. If opioids are not helping patients achieve functional improvement in their day -to-day lives, the risk of continuing or increasing dosages might outweigh the benefits,” said Dr. Craig Ross, Regional Medical Director, Liberty Mutual. “We were also concerned about the combination of opioids with benzodiazepines, which significantly increases the risk of overdose.”

“Both of these issues were addressed in the final guidelines, and we were able to quickly incorporate these guidelines into our claims framework to help mitigate opioid misuse and abuse,” stated Dr. Ross.

A Data-Driven Approach to Flagging Risk

Liberty Mutual also focuses on early intervention and communication. Identifying high-risk claims early on is key to protecting employees from opioid dependence. The company’s analytics team uses a data-driven approach to flag these cases. Often, the psychosocial factors of a claim provide good indicators of whether an injured worker is at increased risk for drug dependence.

In addition, the company’s pharmacy benefit management partner helps provide a complete view of an employee’s opioid use by monitoring overall dosage. Liberty Mutual can also track physician prescription patterns and identify those who may be prescribing too early or frequently.

Conversations from the Start

“If an injured worker is prescribed an opioid, the claims handler receives a system alert to review the prescription,” McCarthy said. “The next step is to reach out to the treating physician and to connect with one of our nurses or regional medical directors for a strategy consult.”

“We train our claims handlers to ask questions,” Dr. Ross said. “If the prescription doesn’t adhere to the CDC guidelines, why not? Is it improving functionality? If not, can we explore some alternative treatment options?”

Relaying that information and guidance to an injured worker is delicate and nuanced. Every patient’s case, personality, and disposition is different. It’s important to make complex medical information simple. Because Liberty Mutual equips its claims handlers with strong client relations skills, they are able to explain to patients why their prescriptions may not be appropriate for them.

Applying the Claims Framework to Medical Marijuana

The Liberty Mutual claims management framework – evidence-based treatment, proactively identifying high-risk cases, engaging providers and patients early and often– can be applied to any emerging risk, including medical marijuana.

While not yet common in workers’ comp cases, medical marijuana is likely to gain popularity as more states pass laws that legalize use.

“There is little evidence that medical marijuana is an effective treatment for workplace injuries,” Dr. Ross said.

Liberty Mutual’s claims team carefully monitors the legal and regulatory environment in each state. “As part of our approach, if an injured worker asks to be reimbursed, we hold a roundtable discussion with the claims team, legal team, and a regional medical director to determine if it’s the most appropriate path,” Dr. Ross said.

The top concern for employers is that medical marijuana will impede a worker’s ability to do his or her job, potentially resulting in injury to themselves or to coworkers, or property damage.

“We work with employers on a case-by-case basis to determine the exposure and work within the confines of their workplace safety programs and policies,” McCarthy said.

While the use of medical marijuana is still in its infancy in workers’ comp, Liberty Mutual’s problem-solving framework helps businesses tackle changes as they come, always pursuing the best outcomes for injured workers.

To learn more, visit libertymutualgroup.com/workerscomp.

1 https://www.cdc.gov/drugoverdose/data/overdose.html
2 http://helioscomp.com/insights/influence/opioids

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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 Liberty Mutual Insurance. The editorial staff of Risk & Insurance had no role in its preparation.

 

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Liberty Mutual Insurance offers a wide range of insurance products and services, including general liability, property, commercial automobile, excess casualty and workers compensation.

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]