Let's Reduce Lost Time --- Medical Case Management

As mentioned in my last posting, Oklahoma gets a low ranking compared to other states in the category of lost time. How can we improve our standing and get workers back to work quickly?

At the Court we think we are doing our part. Time to trial for nearly every judge is six to eight weeks, just the right amount of time for the attorneys to be prepared. So what else can we do?

I believe that much of the delay outside the courtroom can be ameliorated by judicial appointment of medical case managers.

What criteria should we use to decide when appointment is appropriate? Based on my experience dealing with cases ranging from the mundane to the tar-baby, certain events or circumstances are red flags that in the future will trigger consideration of case manager appointment. They include:

• Claimant has missed work for more than thirty days
• Injury to multiple body parts
• Claimant has drug problems or is predisposed to them
• History of missed appointments
• Presence of comorbidities, such as obesity, diabetes, heart disease or heavy smoking, that potentially mask symptoms or impede recovery
• Insurance carrier uses out of state adjusters or multiple PPOs

If my readers have suggestions to modify or expand this list, please contact me with your ideas at by posting a comment to this item or replying to your email notification.

A Fool's Gambit

When it comes to workers' compensation reform, why or why can't we be more like Texas. . .or Kansas. . .or Missouri. . .or this time, Arkansas? Well, take your pick, because yet another state by state scorecard for workers' compensation has been published. Read the analysis and conclusions in Risk and Insurance, one of my favorite websites.

When ranked in the categories of Low Lost Time Frequency, Short Duration of Disability, High Benefit Generosity, Low Insurance Cost, the states received a letter grade and a composite ranking from 1 to 9. Oklahoma ranked 7 (C+).

But look, Arkansas ranks 3 (A-). Isn't a group working on a "modified" Arkansas plan for another round of workers' comp reform. Did anyone notice that Arkansas ranks near the bottom for injury benefits? Only seven states have lower benefit rankings. It sounds so high-minded to say we will scrap the old system for a new high performing one that moves us to the head of the class. But what are the hidden costs and tradeoffs? For Arkansas low benefits (C) equals low costs(A+). Sounds easy.

What about the number one state, Massachusetts? It has high benefits (A+) and low cost (A+). They have worked at improving their system for 15 years, starting under Republican governor William Weld --- not your usual 90-day wonder that we are always promised. They broadened the number of covered workers by eliminating uninsured independent contractors. In Oklahoma we try to make it easier to work without coverage. They tuned up their existing system by cracking down on the fraudulent underreporting of wages. Why is there more talk about that?

In the final analysis, modeling Oklahoma after another state is a fool's gambit, taking an uncalculated risk for an intangible gain. Let's face it. We may never get high marks in some of the categories. For example, duration of disability may be influenced by unreported factors, Oklahoma's consistently high rankings in obesity, heart disease and diabetes. This complicating factor may never change and thus dampens any attempt to reduce lost time. So why should we throw out the baby with the bath water, and fill the pan with another state's bath water?

Instead, we should be committed to continuously improving the existing system. Our mission should be to get workers back to work as expeditiously as possible. One of our goals to accomplish this mission should be to streamline the authorization process for medical treatment. We will measure of our success by steadily climbing up the rankings ladder, not taking one giant step to the top.

Our Aging Workforce

Aging America: The Iceberg Dead Ahead by Tom Lynch, founder of LynchRyan, Inc., is a remarkable article on the potential impact of older workers on the workers' compensation system. Baby boomers are reaching retirement age but 50% will defer retirement for a variety of reasons: global economic meltdown, rising health costs, inadequate social security and Medicare systems.

Generally the higher cost of treating injuries to older workers is offset by their lower accident frequency. However, the data does not consider the growing proportion of aging workers. Lynch predicts losses will rise significantly due to Boomer injuries, driving up employer premiums.

Good read for the weekend.