Column: Workers' Comp

Opt Out and the Rhetoric Rift

By: | December 14, 2015 • 3 min read

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

It’s been interesting observing the rhetoric wielded in the battle for public opinion, fought over whether to allow employers to leave behind state workers’ compensation systems.

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“Opt-out” proponents talk about “The Option,” which they say would let employers create alternative injured-worker plans that ensure employees receive the best possible care — better than under current state workers’ comp systems.

They tout opt-out plans as free enterprise arrangements and they promise to openly share data on the positive medical outcomes achieved.

Critics counter that efforts to “kill” current workers’ comp systems would reduce employer costs by slashing benefits and preventing injured workers from filing claims that are currently compensated.

Opt out, opponents say, would create one-sided systems with employers controlling medical treatment, indemnity amounts and the appeals process, while obfuscating data on the treatment of injured workers.

Rhetoric wielded to shape legislative outcomes is common when interest groups vie to win their vision of how state workers’ comp systems should operate. But it feels different this time, perhaps because of the stakes.

Normally, battle lines form over legislative proposals that are limited to remedies for specific problems within state worker’s comp systems.

Rhetoric wielded to shape legislative outcomes is common when interest groups vie to win their vision of how state workers’ comp systems should operate.

The rhetoric in the opt-out war, however, seeks to influence opinions about the fundamental value that workers, employers and society derive from existing workers’ comp systems.

Ideally, proponents would like to win the right to exit workers’ comp systems nationwide and implement entirely different mechanisms, not mend the old.

Newspaper opinion pieces, blogs and conference presentations have all been drafted into the war of words with public relations firms and lobbyists conscripted into the effort.

The result has been the likes of a newspaper editorial written by insurance agents in Tennessee, where opt-out proponents are trying to expand their reach.

The agents’ opinion piece warns of “threatening consequences for the state, its business environment, businesses and workers,” and says the current program is “fundamental to Tennessee’s positive business climate.”

For the other side, the Association for Responsible Alternatives to Workers’ Compensation (ARAWC) counters that opt out “can deliver better medical outcomes and higher satisfaction for injured workers without the cost and administrative burden of traditional workers’ compensation.”

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I can’t blame employers for funding ARAWC and thinking they can do better outside workers’ comp systems that pile costs, litigation and administrative burdens on them.

But unfortunately for their side, most published articles and blog postings — as of the writing of this column — report that injured workers would get a raw deal without fair representation of their interests. There have also been reports that Democratic lawmakers in Washington want a federal evaluation of workers’ comp nationwide, in part because of concerns that certain practices, potentially including opt out, shift costs onto public programs.

The news reports and blog postings do not support the narrative opt-out proponents prefer. But that is not a death blow to their closely watched efforts.

Who knows where this will go as political battles over opt-out legislation continue into next year. But you can expect the rhetoric will continue.

Workers’ comp is a complicated topic, hard for politicians and the general public to comprehend. Rhetoric, on the other hand, conveniently simplifies it for them. It doesn’t require the deciphering of facts and it tugs at the emotions rather than raising questions requiring deeper analysis about the future impact on everyone.

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

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