Disability

VR in Workers’ Comp

Health care researchers and workers’ comp insurers are discovering the versatility in virtual reality as a new tool for treating patients and training workers.
By: | February 20, 2017 • 5 min read

Virtual reality is fast becoming a useful new workers’ compensation tool.

Health care researchers are testing novel ways to incorporate VR into patient rehabilitation while workers’ comp insurers are using it to better train adjusters and underwriters.

Areas where the application has promise include catastrophic injuries such as spinal cord injuries, phantom limb pain after amputation, severe pain after burns and rehabilitation.

“The industry is starting to use it,” said Zack Craft, vice president, rehab solutions, at One Call Care Management. “It’s being discussed at almost every rehab center out there.

Zack Craft, vice president, rehab solutions, One Call Care Management

“They see workers’ comp as a good area to test the waters; they see this as a funded source,” he said.

So how does a video image displayed on a large screen or headset help treat catastrophic injuries?

VR may help injured employees cope with pain and regain mobility after serious accidents. VR therapy may improve balance and help with motor learning and mobility. Incorporating video games with the therapy might also keep patients engaged and interested in rehabilitation for longer.

Treatment can be individually designed per patient based on the injury.  Biometrics can measure and adjust to how quickly patients are recovering. The development of the technology, though, is still nascent.

“I think we’re still years away from decent guidelines on which technology to use on certain conditions and for how long and what outcomes we can expect,” said Dr. Robert Goldberg, chief medical officer at Healthesystems.

Doctors tried VR in a study to determine if the technology can help in pain relief while changing bandages on significant burns. Results from the first group of patients were promising.

One of the most exciting potential areas for workers’ compensation payers is the way VR might also be used to replace or reduce opioids in the treatment of pain.

Advertisement




Opioids are a huge cost for payers. That’s because the drugs are so widely prescribed, are addictive and prescription coverage for them can continue for years without remedy.

It is thought VR can help divert the injured worker’s thoughts away from lingering pain and reduce use of addictive painkillers.

“We’re on the cusp of something almost revolutionary if they can manage chronic pain,” Craft said.

“We need to show that the technology works in a way that makes financial sense.” — Zack Craft, vice president, rehab solutions, One Call Care Management

“When your brain is distracted and immersed into a full-body sensory experience it doesn’t focus on pain,” he added.

VR might also offer improved mirroring, a technique already used to help with phantom limb pain. Again, the VR display distracts the patient from focusing on the nerve-ending pain. That may help to rewire the brain to sense less pain and begin to recognize the missing limb.

Currently, VR is most commonly applied to the care of mental health conditions such as depression, post-traumatic stress disorder, autism and ADHD.

Far from the doctor’s office, VR is already playing a big role in workers’ comp as a training tool for employees, underwriters and adjusters, said Mahendra Nambiar, vice president of global insurance solutions and innovations lead at Capgemini.

“The No. 1 way we see VR used in workers’ comp is from the training space,” Nambiar said.

VR can be used to better train workers, such as a forklift operator, how to do a job more safely and avoid injuries, he said. It can also help the adjuster or underwriter learn to do a more consistent job when conducting a workers’ comp safety assessment.

“The uniformity and quality and inspection goes way higher” when VR is used for training, Nambiar said. VR training is often easier and cheaper than instructor-led teaching, he added.

There’s Promise to the Technology

Healthesystems’ Goldberg said he is hopeful about new uses for treating injured employees.

Dr. Robert Goldberg, chief medical officer, Healthesystems

“There’s promise to this technology,” he said.

Yet, there’s reason for concern.

Last year, the Federal Trade Commission fined the creators of the Lumosity “brain training” programs $2 million for deceiving consumers with marketing claims that their games can help users perform better at work and school, and reduce or delay cognitive impairment associated with age.

“Lumosity preyed on consumers’ fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer’s disease,” said Jessica Rich, director of the FTC’s Bureau of Consumer Protection in a statement.

“But Lumosity simply did not have the science to back up its ads.”

Virtual reality can best be used as medical treatment when evidence-based care is already established, said Skip Rizzo, the director of medical virtual reality at the Institute for Creative Technologies at the University of Southern California, in Playa Vista, Calif.

For example, mirroring is already proven to help patients with phantom limb pain by using a real mirror. VR is simply a new tool to improve on the proven technique.

One Call is looking at ways to measure different outcomes when using VR, such as quality of life improvements, cost and clinical outcomes. The company is also developing ways to track and develop its own VR data.

“We need to show that the technology works in a way that makes financial sense,” Craft said.

The Cost of the Technology and the Treatment

According to a “2016 Goldman Sachs Global Investment Research Report,” the virtual reality and augmented reality market could reach $80 billion in revenue by 2025. Its use in health care alone could generate $5.1 billion in sales.

“Looking beyond video games, we see real estate, retail and healthcare among the first markets that VR/AR disrupts,” Goldman Sachs said in the report.

Advertisement




“I think you’ll see it impacting claims this year,” Craft said. “Over the next one to two years I can’t even image where we’ll be with it.”

Goldberg expects workers’ comp payers will probably decide each case individually.

“I don’t think they are going to hold back on new technology scripts,” Craft said.  Some insurers are going to be very willing to approve scripts on VR rather than opioids, he said.

The challenge pertains more to the cost of VR’s technology than its medical value. Carriers will need to understand how to vet VR products, and recurring costs.

The technology may become obsolete more quickly than expected and there are other data costs that may make it difficult for adjusters and case managers to gauge the projected cost of the equipment for each claim.

The good news is that the cost of the VR technology is falling.

“It’s exciting because every day there’s new technology,” Craft said. “It’s no longer in the future; it’s here.” &

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

More from Risk & Insurance

More from Risk & Insurance

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.

Advertisement




Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.


R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.

Advertisement




We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?

Advertisement




Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.

Advertisement




Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now an where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.

Advertisement




More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

The R&I Editorial Team can be reached at [email protected]