Sponsored Content by IWP

Where Workers’ Comp Can Do Better for First Responders

Including first responder mental health coverage in workers’ compensation calls for a shift in the definitions of a workplace injury and compensable treatment.
By: | August 10, 2017 • 5 min read

In 2012, police officers and paramedics were called to Sandy Hook Elementary School in response to a shooting that took the lives of 28 people, mostly children. In 2015, chaos erupted at an office holiday party in San Bernardino when a gunman and his wife opened fire on his colleagues. In 2016, first responders converged on Pulse nightclub in Orlando to stop a shooter who cornered many of his victims inside.

Those are perhaps the most newsworthy stories of violence and terror that have gripped the American psyche in recent years, but similar scenes have occurred in a total of 40 states across the country.

In their wake, first responders who see the carnage firsthand are left to grapple with the psychological ramifications of tragedy.

“States are seeing how these traumatic events impact first responders and are starting to ask, how can we help the people that we send into these horrible situations?” said Danielle Jaffee, Manager of Government Affairs, IWP. “The problem is that existing workers’ compensation statutes were not written to accommodate first responders specifically, or mental health claims in general.”

Including first responder mental health coverage in workers’ compensation calls for a shift in how state legislatures define a workplace injury, and how they think about compensable treatment.

Legislative Challenges

Danielle Jaffee, Manager of Government Affairs

States fall into one of two buckets: first, there are the states that require a physical injury to be attached to a workers’ comp claim. For those states, redefining what qualifies as an injury will be the biggest obstacle in incorporating mental health care into workers’ compensation.

“In many states, a physical component is a requirement to file a workers’ comp claim,” Jaffee said. “If you have a broken bone, we can clearly see that on an X-ray, we know it needs a cast, and we know it will take about eight weeks to heal.”

Intangible mental injuries like post-traumatic stress disorder cannot always be objectively and definitively identified, and the treatment plans are less clear-cut. Allowing workers’ comp claims for this type of injury introduces uncertainty that not all lawmakers are comfortable with.

“We don’t know how many people will file a claim, how long they will need care for, and what the cost will add up to,” Jaffee said. “And of course no one can predict when the next traumatic incident will occur or what its scale could be.”

And when the claimants are publicly-employed first responders, the burden of paying for care falls on the shoulders of cities, towns and municipalities — entities often saddled with very limited budgets. The combination of claim unpredictability and potentially unaffordable care is what keeps many states from getting legislative measures passed.

“Discussions in those states are centered on the best way to add mental health care to workers’ comp without a physical injury, so that they can take care of first responders without overtaxing the system,” Jaffee said.

Then there are states that fall into the second bucket: those that do allow workers’ comp claims for mental health injuries, but stipulate that the event that triggered the claim must be outside of the normal scope of the claimant’s work.

“That would automatically exclude first responders,” Jaffee said. “Being in dangerous and traumatic situations naturally falls within their job descriptions.”

So for these states, the question at the center of the debate is: who should get coverage?

If they remove the exclusion that the triggering event must be out of the ordinary, every employee in the state could reasonably find grounds to file a mental health claim, which increases the likelihood of fraud and the cost that comes with it.

“Everyone experiences stress at work — but everyday stresses cannot be the basis of a workers’ comp claim,” Jaffee said. “Statutes need to include language that specifies mental health coverage — without a physical component — that applies only to first responders. This will help to contain the claims.”

State of the States

Despite the legislative challenges, the need to care for first responders’ mental health is no longer something states can push aside. Our 24/7 news cycle that readily broadcasts the aftermath of violence and disaster, combined with increased awareness around PTSD and mental health in general, have spurred efforts to make an old system work for a modern day problem.

“Since 2012, we’ve seen 10 to 15 states examining ways to help our first responders amid an increase of PTSD claims,” Jaffee said. “Connecticut really lead the charge after the Sandy Hook shooting brought this issue to the forefront.”

But five years later, Connecticut is still trying to find a way to make it work. A bill that would include coverage for PTSD when a first responder witnesses the death or aftermath of death in the line of duty, regularly fails to pass out of the legislature.

Florida, Texas, Maine, Colorado, Minnesota, California and Vermont are among others examining the issue. Florida introduced legislation this year to allow claims of mental health ailments without a physical injury, and Texas proposed a bill to presume that PTSD in first responders was related to their job, provided it was not diagnosed earlier.  In Ohio, though no bill is in the works, police officers have been lobbying for years to have mental health care provided by the workers’ comp system.

“They are recognizing the need for this care among their members,” Jaffee said. “But it is a unique problem for each state because the language of workers’ comp statutes varies across the country.”

Advocating for Change

As the “patient advocate pharmacy,” IWP tracks the regulatory and legislative updates across all 50 states and engages with lawmakers, insurers, physicians and patients to bring discussion around the issue into the spotlight and keep the conversation going.

“Seven to eight percent of American adults, or roughly eight million people, will have PTSD in their lifetime,” Jaffee said. “We’ve seen the need for mental health care among our patients and asked ourselves, ‘is this an injury we can help to heal?’”

Jaffee and the rest of the Government Affairs team at IWP aim to educate workers’ comp stakeholders through face-to-face meetings and informational whitepapers. They also work to afford injured workers a voice by weighing in on proposed legislation through public comments.

“We’re trying to spark the conversation around the mental health care needs of first responders, because doing so will ultimately help them gain access to the services they need to go back to work,” Jaffee said. “We support efforts that states are making to work through a complicated issue to better serve their workers.”

To learn more, visit https://www.iwpharmacy.com/.

 SponsoredContent

BrandStudioLogo

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with IWP. The editorial staff of Risk & Insurance had no role in its preparation.




IWP is a national home delivery pharmacy service working as an advocate for injured individuals. Fully licensed in 48 states, IWP enhances patient access and alleviates administrative and financial burdens.

Catastrophe Risk

Material Resiliency

New materials, methods and ideas are empowering property owners to rein in their catastrophe risks.
By: | October 12, 2017 • 11 min read

The 2017 hurricane season is one for the record books. Rebuilding efforts are underway, with builders working to make insureds whole again as soon as possible … at least until the next storm comes along.

Advertisement




And therein lies the problem with recovery in disaster-prone regions. It evokes the oft-quoted definition of insanity: Doing the same thing over and over again and expecting a different result.

So what if we did it differently? What if instead of rebuilding to make structures “like new,” we rebuilt to make them better, more resilient, less prone to damage?

The reality is, we don’t really have a choice. Climate change is ushering in weather systems that are increasingly volatile. Wildfires are raging like never before. Sea-level rise is threatening our coasts, and there’s no way to dial any of it back.

Nevertheless, people will continue to build homes and businesses along the coast. Real estate developers will continue to nestle luxury homes into wooded foothills.

That means communities need to come to terms with the risk and plan for it intelligently.

Michael Brown, vice president and property manager, Golden Bear Insurance

“Natural disasters are going to happen,” said Michael Brown, vice president and property manager with Golden Bear Insurance. “But if we plan and build communities around the idea that something bad may happen someday, then that community can bounce back faster afterward.”

In any natural disaster, he added, “the property damage is extreme. But the biggest portion of the losses, both insured and uninsured, are the time element pieces. How long was the business closed? How long were homeowners unable to occupy their homes? Those are the pieces that drag on for months — years in some    cases — and really drive the economic loss.”

That’s the motivation behind new materials, designs and strategies being implemented in the construction and repair of at-risk residential and commercial properties.

Powerful Flood Solutions

Newer building products move the needle significantly in terms of efficacy.

For new or restored structures in flood-prone regions, Georgia Pacific produces gypsum panels that incorporate fiberglass mats instead of paper facings and comply with the latest FEMA requirements for flood damage resistance and mold resistance. Wall boards made from magnesium oxide (MgO) don’t absorb water at all and have the added benefits of being environmentally friendly and non-flammable.

In the UK, advanced flood-resilient structures built with water-resilient concrete-block partitions are being fitted with not only MgO wallboards, but also wood-look porcelain or ceramic flooring that’s non-permeable and fire-resistant — without sacrificing aesthetics. Drains are installed in the flooring, along with sub-flooring gullies and submersible pumps that push the water back outside. Outlets and appliance motors are all situated above expected flood levels. Doors are equipped with sliding flood panels.

In the event of flooding that exceeds a depth of two feet, automatic opening window panels (flood inlets) are triggered by sensors to allow flood water to enter the property slowly, to reduce external pressure that could damage the structure.

Carl Solly, vice president and chief engineer, FM Global

Controlled inflow buys time for a homeowner to raise furniture up on blocks, or for a business owner to raise pallets of goods up to higher shelves or move equipment to a higher elevation.

Water intrusion is reduced dramatically, and even when it happens, there is little to no damage. Water is pushed into the floor drains, surfaces are allowed to dry, and then it’s back to business as usual in days rather than months — likely with no insurance claim filed.

Dramatic improvements are happening on this side of the pond as well. For entities that need permanent on-site flood solutions, barriers like flood gates and retractable flood walls are the most sophisticated they’ve ever been.

After suffering $4 billion in damage during Superstorm Sandy, New York’s Metropolitan Transit Authority invested heavily in flexible fabric flood panels that are made with Kevlar® and can be unrolled quickly and easily. Additional flood gates hinged to air grates are passively activated by the weight of incoming water entering the grates.

Advertisement




The transit authority is also testing a prototype “resilient tunnel plug” — essentially a giant air bag that can be deployed quickly to seal off sections of subway tunnel. The plug is designed to withstand not only flood but also biochemical attack.

Even temporary solutions are leaps and bounds beyond the days when sandbagging was typically the best option. New as-needed barrier methods include inflatable bladders that can be placed around a building’s perimeter and filled with water to keep floodwater and flood debris at bay.

“People have always said, ‘Well, I’m in a flood plain, it’s inevitable. It’s an act of God,’ ” said Carl Solly, vice president and chief engineer, FM Global. “In the last several years, we’ve really been trying to deliver the message that you can do something about your flood risk.”

Shake, Pummel and Burn

Flood is far from the only problem benefiting from smart engineering. FM Global is working with manufacturers to develop and certify roofing material designed to better withstand the localized hailstorms that often plague southeastern and midwestern states.

Current materials rated for severe hail can withstand hailstones up to 1 ¾ inches in diameter. The new product, rated for “very severe” hail can tolerate hailstones up to 2 ½ inches. The difference sounds small, but it’s far from it.

“It’s about three times the amount of impact energy when it hits the roof [compared to a 1 ¾ hailstone],” explained Solly. “That’s a big difference.”

As for “bouncing back” after a catastrophic fire, Solly said that’s a fairly tall order. But even there, technology is helping to reduce the severity of fires so that disruption is minimal.

FM Global researchers recently pioneered the concept of SMART sprinklers — shorthand for Simultaneous Monitoring and Assessment Response Technology — which can sense a fire earlier than traditional systems and activate targeted sprinkler heads when needed and shut off once the fire is out.

“You’ll catch it with less water, so from a water usage perspective, a water damage perspective and a smoke damage perspective, we think that has an opportunity to be a big difference-maker in the fire protection industry, particular with high-challenge fires,” said Solly.

“You’ve got a better chance of stopping what normally would be a really tough fire to catch.”

In addition, added Brown, smarter sprinkler systems, much like burglar alarms, could be programmed to notify the fire department instantly, even when a structure is unoccupied.

For earthquake risk, said Brown, resilient building efforts are less about new materials than they are about more strategic ways of using traditional materials.

“Here in California we wrap homes in stucco around the wood frame to help the whole building move as a unit. Stucco is concrete so it does crack. I end up with a building that’s got some cosmetic damage … but you don’t have to rebuild the building. It does its job in terms of absorbing a lot of the ground motion before it pushes the building beyond its design tolerances.”

Using stronger, larger steel brackets where the walls meet the roof or the floor or each other, said Brown, “keeps the north wall from moving in one direction while the west wall moves a different direction.”

Those kinds of stress points can push modest earthquake damage to catastrophic levels, he said.

One earthquake innovation still in the beta phase is a project out of the U.C. Berkeley Seismological lab, using the accelerometers in smartphones as virtual seismometers. Participating phones have an app that detects certain types of ground motion. As phones pick up earthquake wave patterns, they ping the server which checks nearby smartphones to see if they sensed the same pattern, all in microseconds. If an earthquake pattern can be confirmed, an alarm will be sent to every cellphone within a logical radius.

That might only buy people an extra two to five minutes before the event, said Brown, “but if you are the operators of Bay Area Rapid Transit commuter trains, that’s enough time to slow all the trains down to five miles an hour. If you are Google, that’s enough time to park a bunch of hard drives in your server farm so that they’re better able to resist shaking and not be damaged too badly.”

Raising Standards

Cost, of course, will impact the take-up of resilient materials and tools. If it’s three times more expensive to build a home out of the resilient materials, a lot of builders aren’t going to want to because the home will be tougher to sell.

Advertisement




FM Global’s Approvals division tests and certifies a variety of products aimed at mitigating disaster peril. That can help increase property owner confidence in these materials, particularly for commercial structures.

“When you’re betting millions of dollars and the future of your business — or at least the near-term future of your business — you really need to know that it’s going to work,” said Solly.

With just-in-time manufacturing, a company may have a few days’ worth of stock on hand rather than three months’ worth.

“So you can’t afford to be out of business for weeks, because your customers are going to go somewhere else for your product,” he said.

Building standards and codes can help drive adoption of resilient measures in both commercial and residential construction. But more work needs to be done to raise standards to meet the goal of resilience.

Effecting real resilience is something leaders across the spectrum should be talking about, including brokers and carriers, government and research agencies, building products manufacturers, and corporate executives.

If lives are saved in an earthquake, but a building is still damaged to the point where it needs to be torn down, said Brown “that building owner, that community, is going to have a much longer path to full recovery. We want the building codes strengthened to an immediate occupancy [goal] — we want people to be able to move right back into that building so there’s a much shorter window of disruption.

“It’s certainly better for me as the insurer,” he said, “but it’s even better for the guy that owns the building or runs his business out of it because now his employees still have a place to come to work and they can still get paid.”

Every single business able to minimize its downtime in this way helps the entire community be more resilient, he added. It creates that snowball effect in a good way. When businesses are able to stay open or reopen quickly, he said, workers don’t lose a meaningful amount of pay. Everybody’s in a better position to continue shopping and supporting the local economy.

“If you just shorten the line of people who are looking for some sort of federal aid, or state aid because they’ve had a massive financial disaster — maybe we can turn those into moderate to small financial disasters. That’s the key, I think, to communities being more resilient.”

Driving Demand

As the likelihood increases that property owners will experience a second loss or even third loss, some insurers are looking at ways to invest in resilience — a smarter long-term business plan than paying to rebuild again and again.

One new initiative is Lex Flood Ready, the product of a partnership between Lexington Insurance and The Flood Insurance Agency (TFIA). Flood Ready is a coverage enhancement for Lexington Private Market Flood clients that will not only indemnify property owners that suffer flood damage but will also provide the funds to rebuild them to a higher standard of resiliency when replacing floors and walls.

Advertisement




Resilience proponents advocate a variety of approaches to encourage take-up, including tax credits, resilience grants, insurance incentives and other partnerships, as well as encouraging lenders to engage borrowers by making the flood risk assessments part of the mortgage process.

A certification scheme similar to LEED could also help drive resilience efforts. The UK is currently beta-testing a certification program called Home Quality Mark, developed by the Building Research Establishment (BRE). Properties are rated on stringent criteria that considers not just disaster resilience, but energy performance and cost, durability and environmental impact.

“Getting people from diverse perspectives thinking about it and talking about it is going to be the avenue to finding the right answers.” — Michael Brown, VP and property manager, Golden Bear Insurance

That’s something builders would be able to use to add value to their properties, offsetting the cost of building in resilience and driving consumer demand for properties built to the highest standards.

With increased resilience will come questions for insurers, said Brown. “It will open up a can of worms.”

It will create something of an arms race among insurance companies, he said. “Who’s going to be the first one to figure out what’s the right way to insure that? What’s the right price? What are the right terms and conditions?” Admittedly, it’s a good problem to have.

Effecting real resilience is something leaders across the spectrum should be talking about, including brokers and carriers, government and research agencies, building products manufacturers, and corporate executives.

“Getting people from diverse perspectives thinking about it and talking about it is going to be the avenue to finding the right answers,” said Brown.

“That kind of mentality top to bottom in the industry is going to be necessary. It’s not the first time we’ve dealt with disruptive things and we will continue doing it. It’s what keeps the game interesting.” &

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