Brad Wright of Wright on Health tees up all the health wonkery this week as he hosts Health Wonk Review: A Masterful Edition.

Texas - Texas does things differently and their work comp program is true to course. Employers are not mandated to have workers comp insurance - they can opt out. According to a 2010 survey, 15% of businesses with 500+ employees choose to opt out. And now Walmart is opting out of work comp in Texas. See more on this at PropertyCasualyt360, including a graph of market share for the top 10 insurers comparing 2010 to 2011: Concerns Arise over Texas Workers' Comp. State System After Walmart Drops Out

Mississippi reform - Mississippi is working on workers comp reform and we note that one provision about "medical proof" establishes a pretty high bar to hurdle for some injuries; for example, a back injury: "It also would require a worker to provide the employer with medical proof that an injury or illness is a direct result of the job if the worker's claim is contested."

Dirty Business - Is workers' comp dirty? Some people seem to think so and Dave DePaolo considers whether there's more to the frequent use of the term than coincidence. See Work Comp and Dirt - Do They Have to be Synonymous?

Florida drug wars - Tampa Bay Times says that drugstores are the new focus of painkiller investigations. From the article: "The U.S. Drug Enforcement Administration says that in 2009 no Walgreens retail pharmacies were listed among the DEA's top 100 Florida purchasers of oxycodone -- a key ingredient in OxyContin, Percocet and Percodan. / By 2011, 38 Walgreens made the list. By February, the total reached 53 of the top 100. So says a warrant filed last week in U.S. District Court for the Middle District of Florida. / In Fort Myers, the DEA says one Walgreens pharmacy sold more than 2.1 million oxycodone pills in 2011. That's more than 22 times the oxycodone sales at the same pharmacy two years earlier."

Healthcare's 1% - Who are the chronically costly? The costliest 1% of patients consume one-fifth of all health care spending in the U.S., according to federal data. Doug Trapp of amednews digs into the data to profile the most costly patients and where so much of the medical spend goes.

From the courts - Fred Hosier of SafetyNewsAlert has an interesting post about whether workers comp will be on the hook for prescribed drug's side effects. He cites a case related to a West Palm Beach police officer who has filed for additional workers' comp benefits for the treatment of his gynecomastia, an excess growth of breast tissue, a side effect of medication he was prescribed to treat a work-related injury. Initially denied, an appeals court has reopened his claim for review by an expert medical advisor.

Occupational Medicine - It's been a bit since we visited the American College of Occupational and Environmental Medicine (ACOEM) site. ACOEM offers up a few new guides, and a revision of an older guide - Fatigue Risk Management in the Workplace (PDF), Guidance to Prevent Occupational Noise-Induced Hearing Loss and Guidance for the Chronic Use of Opioids.

Affordable Care Act - At Health Care Policy and Marketplace Review, Bob Laszewski looks at what individual health insurance might cost if the court strikes the mandate down and still requires insurers to cover everyone. Hint: a lot.

Briefly....

• US Labor Department's OSHA announces new National Emphasis Program for Nursing and Residential Care Facilities
• Light-duty work 387 miles from home not 'suitable'
• Big Mistake for Employers to Demand Employees' Facebook Passwords
• There's no such thing as lawsuit avoidance in 2012
• Mike Wallace's battle with depression leading to a suicide attempt
• Seven Key Slicer Errors to Avoid
• Oil and gas operations safety

Here's a grab bag of apps for health & safety, human resources, insurance news - and even for ADA job accommodations.

EH&S; Apps for All Seasons - Occupational Health & Safety compiled apps that have particular relevance to safety, health, and environmental professionals - and risk managers too, we might add. These range from weather and traffic alerts to tools for chemical safety, first aid and emergency response.

Top 5 Risk Management Apps - apps for insurance terminology, insurance publications and a mobile flood map.

Apps for ADA Accommodations - HR Daily Adisor offers a variety of suggestions from the Job Accommodation Network for apps that address speech, hearing and visual impairment.

10 Apps That Can Save a Patient's Life - Emergency Monthly scoured the MedGadget archives to compile the top 10 smartphone applications that can save a patient's life ... before they get to the emergency department. The 10 apps presented have been grouped into the four primary categories: workflow, emergency response, vitals, and diagnosis.

10 Mobile Apps That Promote Safety - SocialTimes offers a roundup of apps covering emergency preparedness, driving safety, alerts, first aid, and medical diagnostics for communications between patients and physicians.

In HR? There's an App for That - a roundup of apps from SHRM for recruiting, analytics, time-and-attendance tracking, performance feedback and more.

Clayton Osbon, 49, served as a pilot for Jet Blue Airlines for 12 years. On March 27 during Flight 191 from New York to Las Vegas, he suddenly began raving about terrorists and started pushing buttons and flipping switches in the cockpit, all the while telling air traffic controllers to shut up. His co-pilot had the presence of mind to suggest Osbon, the flight captain, go to the bathroom. When Osbon did, the co-pilot and another JetBlue pilot on board locked him out of the cockpit. Osbon started banging on the door and had to be subdued by passengers on the flight.

Osbon is now charged with interfering with a flight crew - an intriguing conundrum, as he was head of the flight crew with which he interfered. Osbon had passed a physical a few months prior to the incident, although it is unlikely that a detailed mental health evaluation was part of that physical.

Osbon's friends have stated that he has no history of mental illness and had exhibited no symptoms that would have foretold the bizarre behavior on flight 191. It appears that with no warning signs, Osbon simply snapped, putting the passengers and crew at immediate risk.

(Mental) Fitness for Duty
This incident raises important issues about mental health and fitness for duty, especially in jobs which involve not just the well-being of a single worker, but the general public as well. A couple of years ago we blogged the saga of Bryan Griffin, a pilot for Quantas Airlines who had "uncontrollable urges" to crash airplanes. While he never actually followed through on his death wish, he continued to fly for about three years, while suffering from this obvious mental health problem. Quantas chose to risk disaster rather than remove Griffin from his pilot duties. Ironically, thirty years later he was awarded over $200K in disability pay for the stress of flying while he was mentally vulnerable, a ruling which left Quantas - and the rest of us - shaking our heads in disbelief.

In the months ahead we will learn more about Osbon's sudden breakdown, including whether there were subtle indications that something was wrong. But at the heart of this story is the mystery of mental illness itself. While significant advances have been made in both the diagnosis and treatment of mental disabilities, much remains unknown. The Federal Aviation Authority has issued guidance on the use of anti-depressants for pilots, even while admitting that the science is tentative and subject to change. Pilots who are placed on anti-depressants are not allowed to fly for one year; it is reasonable to assume that Osbon will not return to the cockpit for at least a year, perhaps more.

The Paradox of Mental Illness
Even as unprecedented advances have been made in the treatment of mental illness, pervasive prejudice still remains. Individuals seeking care are often stigmatized; there is considerable public pressure for individuals to suppress symptoms and avoid treatment. Insurance coverage for treatment may be spotty, and for those without insurance, the emergency room is usually the only treatment option. In the above referenced guidance, the FAA estimates that about ten percent of the population suffers from depression, with the majority of these people working, raising families, driving motor vehicles and even flying airplanes.

Osbon's case illustrates the difficulty in trying to establish viable policies on mental fitness for duty. As my southern friends would say, it's like trying to nail Jello to a tree. We are reminded that just getting out of bed and heading off to work - let alone boarding an airplane - is an act of faith. We trust other drivers on the road to stay in their lanes, just as we assume that the pilot of our aircraft is rational, detail-oriented and totally focused on the job at hand. We as individuals may be a bit distracted, but everyone else is locked into what they are supposed to be doing. That's not just a leap of faith, that's an Evel Knievel rocket across the Snake River Canyon.

Under the general heading of whistleblowing protection, OSHA has raised concerns about a number of common industry practices designed to lower the cost of workers compensation. Policies such as employees reporting (or not reporting) injuries, disciplinary actions taken against workers filing comp claims, and even safety incentive programs, may discriminate against employees who have been injured. And if discrimination can be proven, employers are at risk for major penalties.

Richard Fairfax, Deputy Assistant Secretary for OSHA, has distributed a memo alerting his regional staff to potential discrimation against injured employees. Now that his staff has been alerted, employers would do well to educate themselves about the issues.

Fairfax's memo identifies four potential areas of discrimination. We'll analyze them one at a time:

Taking disciplinary action against injured employees might involve discrimination
Fairfax points out that an employee's reporting of a claim is a protected act. If injured employees are disciplined every time an injury is reported, this would be a clear case of discrimination. If, on the other hand, the discipline was triggered by specific violation of safety rules, employers could and should document the violation; keep in mind that this type of documentation must be done in all situations, not just where an employee is injured. It is also worth noting that comp, being a no-fault system, would in most instances still pay benefits to injured employees despite the safety violation.

Penalizing injured employees for late reporting of an injury might involve discrimination
LynchRyan encourages employers to require prompt reporting of all injuries; the existence of this type of policy is not in itself discriminatory. However, OSHA will review the application of disciplinary actions on a case-by-case basis, considering such factors as whether the employee's deviation from the procedure was minor or extensive, inadvertent or deliberate, whether the employee acted reasonably, and whether the discipline imposed is proportionate to the violation. In this and other related matters, one shoe does not fit all!

Penalizing injured workers who violate safety rules might involve discrimination
OSHA recognizes the need to enforce legitimate workplace safety rules. However, these rules need to be specific and they need to be enforced and documented on a regular basis, not just when someone reports an injury. For example, safety rules that employees "maintain situational awareness" or "work carefully" are inherently vague and offer the potential for abuse. Employers must be prepared to document that injured workers are not singled out for attention in this area.

Some performance incentive programs might involve discrimination
Many employers reward their workers for injury-free workdays. For example, if no injuries are reported for a 30 day period, workers might be eligible for a raffle or might enjoy a pizza lunch. OSHA implies that these practices might by their very nature stifle the reporting of injuries and thus violate OSHA standards. For example, an injured worker might decide not to report an injury in order to keep the clean record intact. Because the reporting of an injury is a protected act, the employer is vulnerable to charges of discrimination, even though the employee made the decision not to report the incident.

OSHA recommends that safety incentive programs focus not on reported injuries but on safety initiatives: for example, rewarding a crew for completing a safety training program or for identifying and correcting workplace hazards.

Best Practices
In view of OSHA's stance in the area of safety incentive and disincentive programs, employers need to make sure their policies do not discriminate. That means:
1. Be careful to document specific safety violations involving injured workers
2. Before disciplining an injured worker for a late report, examine the circumstances carefully
3. In disciplining an injured worker for violating safety rules, be very specific and document the violations in writing
4. Review any safety incentive programs for the unintended effect of stifling the reporting of injuries; if your program operates in this manner, consider revising it to address OSHA's concerns

Prompt reporting, discipline for safety violations and incentive programs can be useful tools in a comprehensive approach to a safe workplace. Like all tools, they can be misused and abused. OSHA has made it quite clear that the rules themselves might not be sufficient and, in some cases, they might be illegal. Claimant attorneys will surely file the Fairfax memo in their tool box for pursuing claims against employers. Prudent managers should take their own notes and adjust current programs accordingly.

Ken Faulkenberry of AAAMP Blog hosts the latest risk-related roundup: Cavalcade of Risk #154 - Healthcare Mandate Edition. Check it out!

We're happy to bring you this 12-minute, must-watch video commemorating the 100th Anniversary of Workers Comp. The video highlights progress in worker safety, treatment of injured workers and risk management in the past 100 years. In addition to telling the history of comp, it also features three visionary women who were instrumental in furthering health and safety of workers...one of whom witnessed the Triangle Shirtwaist fire. Until this clip, I did not realize the strong role that women played in this history.

Kudos go to Sedgwick as well as to our colleague and friend Peter Rousmaniere. who wrote the script.

Here's some additional information about the women highlighted in the video clip:
Crystal Eastman
Frances Perkins
Alice Hamilton MD

In the 2010 Oregon rankings for the cost of comp insurance, New York comes in 13th, with an average rate of $2.34 per $100 of payroll. That does not sound too bad, until you factor in the extraordinary 20.2 percent assessment that is tacked onto premiums. ** This assessment is double that of the nearest state (Minnesota at 8.9 percent) and nearly five times the average among states. When you combine the already high rates for coverage with the assessment, New York ends up near top of high cost states.

Quoting research from the Workers Comp Policy Institute (WCPI), Risk & Insurance Magazine identifies three major components in the assessment:
- the Second Injury Fund, accounting for half the total
- the Reopened Case Fund that covers claims reopened after more than 7 years
- the Workers Compensation Board, which oversees comp in NY

Recent reforms may eventually reduce the impact of the first two cost drivers, but there is no end in sight for the third. New York operates a huge - and largely redundant - bureaucracy to administer comp claims. Where other states empower insurance companies to make decisions on individual claims, with the state involved only in disputes, New York is involved in every step of every claim. The Board has over 300,000 hearings per year, overseen by 97 judges. The system generates 31 million forms annually, all of which are scanned and saved! Stenographers document every proceeding: a well-intentioned effort to pilot the cost-saving use of video recording devices met with ferocious opposition in the state legislature. The Board employs over 1,300 people; as a point of reference, the Massachusetts DIA, in a state with one third the number of workers, has only 167 employees.

The high cost of insurance might be more tolerable if injured workers were the primary beneficiaries, but this is not the case. The maximum weekly benefit in New York is only $740, which might support a frugal worker in upstate New York, but it will not buy much in the five boroughs. By comparison, Illinois - ranked number 3 for cost - has a maximum wage benefit of $1,288, while MA, ranked 46th, pays up to $1,136.00.

New York is stuck in an archaic system that is fiercely defended by the stakeholders who benefit from its inefficiencies. If only this same energy and commitment were devoted to the protection of disabled workers in the Empire State. Surely, that would be a system worth emulating.

**We heard from our friends involved with the Oregon ranking study, who provided the following clarification:

The Oregon WC Rate Ranking study does include state assessment rates in our index rate computation. We ask our state respondents to provide the rates that are assessed as a percentage of premiums. The NY rating bureau provided us that information in 2010, and there was a 14.2% factor included in the study index rate for NY. Apparently the rate has increased since that time, and the 2012 index rates would incorporate that information in our next study, due out this fall.

Unfortunately assessments are an area that does not lend itself to straightforward comparison. States use different terminology (assessment , surcharge, tax, etc), have different bases for assessment, and fund different functions through this mechanism. So there is plenty of room for different interpretations when looking at the data, depending on where the lines are drawn for inclusion or exclusion.

David Williams has posted Health Wonk Review: Supreme Court week edition at at Health Business Blog - it's a good way to keep up on what's happening in the health care world that may affect your workers comp business. Plus, David's blog is always an interesting read.

More news we've noted

• AIG Exits Workers Compensation As Comp Medical Issues Grow
• 1992 Super Bowl MVP Mark Rypien joins concussion class action suit against NFL
• Farmers Union Cooperative Supply sentenced for grain elevator death of employee
• Gov. Scott quietly signs state worker drug testing into law
• Workplace Stress Can Make You Sick
• 911 Dispatchers Suffer PTS Symptoms from Indirect Exposure to Traumatic Events
• Violence victimizes claimants and employers
• MetLife study: Up to 31 million people ages 44-70 want "encore careers"
• Training program teaches hand signals for miners during emergencies
• Lawyers Add Net Benefit to Work Comp Claims
• NAIC Clarifies Role: It Is Not a Regulator
• How to maintain physician professionalism in social media
• When drafting harassment policies, don't forget about disabilities

And some resources of note:

• What's Wrong with this photo?
• WCGuru Blog
• The Workers Comp Gazette
• OSHA Law Update
• NIOSH Fatal Occupational Injury Cost Fact Sheet: Warehousing and Storage (NAICS 493)
• eLCOSH free use construction safety & health images

Here's a quick summary. In a 50 state overview, there were no "A" students.

The State Integrity Investigation is a $1.5 million public collaborative project designed to expose practices that undermine trust in state capitols -- and spotlight the states that are doing things right. It describes itself as "an unprecedented, data-driven analysis of each state's laws and practices that deter corruption and promote accountability and openness. Experienced journalists graded each state government on its corruption risk using 330 specific measures. The Investigation ranked every state from one to 50. Each state received a report card with letter grades in 14 categories, including campaign finance, ethics laws, lobbying regulations, and management of state pension funds."

Click on the U.S. map to see your state's corruption risk report card. No states scored an "A." New Jersey, Connecticut, Washington, California, and Nebraska scored in the "B" range. Eight states flunked, scoring 60% or less: Michigan, North Dakota, South Carolina, Maine, Virginia, Wyoming, South Dakota, and Georgia. All the remaining states were "C" and "D" students, with our home state of Massachusetts scoring a lackluster 74%, coming in at 10th "best" overall.

How did the insurance departments score?
As citizens, both corporate and private, we find the whole report fairly intriguing, but for the purposes of this blog, we were particularly interested in the ratings for State Insurance Commissions. PropertyCasualty360's Mark Ruquet did a good analysis of this in his article 16 State Insurance Commissions Fail Integrity Evaluation.

The state Insurance Commissions were evaluated on these questions:

• Is the state insurance commission protected from political and special interest influence?
• Does the state insurance commission have sufficient capacity to carry out its mandate?
• Are there conflicts of interest regulations covering members of the board and senior staff of the state insurance commission?
• Are the conflicts of interest regulations covering members of the board and senior staff of the state insurance commission effective?
• Can citizens access the asset disclosure records of the state insurance commission?
• Does the state insurance commission publicly disclose documents filed by insurance companies?

One of the things we like about the map and the site is that you can keep drilling down. Click your state, then click a specific category - such as "State Insurance Commissions," "Ethics Enforcement Agencies" or "Public Access to Information" and then click again to see the specific areas that were evaluated. Click any one of those criteria to see how the score was derived, and click again for further detail. You can also read or submit comments. On each individual state page, there is also a narrative story behind the score and a running list of related news articles.

We'll be spending some time exploring the site further, but our first reaction is positive and we applaud the effort: we love sunlight when it comes to the public good and think it benefits everyone. We'd love to hear reactions about how accurate or inaccurate readers think reports are relative to their own state scores.

Healthcare Economist Jason Shafrin is this week's riskmeister - he hosts Cavalcade of Risk #153, the March Madness Edition. He has filtered this to a nice trim edition of what he calls the "elite 8." We're pleased that he thought our post made the grade!

The Insider does not normally think of state workers comp insurance funds as hubs of criminal activity, but then again, we haven't been to Scranton lately. James McDonnell, 53, is a supervisor in the State Workers' Insurance Fund (SWIF). He makes about $51,000 a year - at least, that's his declared income. He has apparently been pulling in a whole lot more than that. He was arrested this week for running a kickback scheme involving premium discounts for Pennsylvania employers. In exchange for (undocumented) discounts in premiums owed, McDonnell secured cash kickbacks of one third to one half the discount. Between 1999 and 2011, McDonnell and his wife pulled in at least $80,000.

WorkCompCentral (subscription required) offers additional background on this case, including PDFs of the criminal indictment. McDonnell offered premium discounts to individual employers, in one case, a roofer, whose premiums, instead of going up $50K, came down $10K. He then insisted that the roofer join one of the three staffing firms with whom he did business. In exchange for steering clients their way, these firms paid McDonnell a relatively modest 1% commission, in addition to paying him substantial cash kickbacks on the premium discounts. In honor of family values, McDonnell's wife was given several jobs which apparently did not require that she perform any work.

Kickbacks and Harassment
McDonnell must have been a busy man, systematically exploiting his position with SWIF, but he allegedly found time to harass a fellow fund employee. Last September he was accused of "making sexual advances on the employee, identified only as Jane Doe, such as asking her to lick a piece of Twizzlers candy taken from her work desk before he ate it and telling her to bend over and pick up a time sheet he dropped to the ground." Would you be shocked to learn that the fund did not take these accusations seriously?

There may well be slow days at a typical state fund, but McDonnell sure knew how to make time fly. That skill will come in handy when and if he finds himself doing time in a bureaucracy of a different sort altogether.

Comp fraud takes many forms and encompasses opportunities for each and every stakeholder in the system: doctors, lawyers, insurers, state bureaucrats, business people, workers and, I suppose, even consultants. Today's little saga of greed arises from the midst of a state bureaucracy. But no matter where the crime originates, the result is the same: higher costs for the vast majority of people who play by the rules.

Today, we slip back in time to 1925 and put on our Flash Gordon glasses to speculate about the future, a time when a doctor not only "sees what is going on in the patient's room by means of a television screen" but also employs a robotic-like instrument called the Teledactyl (Tele, far; Dactyl, finger -- from the Greek) to "feel at a distance."

This image and the story comes from a delightful Smithsonian blog called Paleofuture in a post entitled Telemedicine Predicted in 1925. The post discusses an article by Hugo Gernsback that appeared in the February, 1925 issue of Science and Invention. You can read more about the intriguing robotoic Teledactyl device and Gernsback's predictions for medicine of the future.

Fast forward to 2010, and we see how remarkably prescient Mr. Gernsback's predictions were. Courtesy of a blog comment by Christoph Hadnagy, we find this link to a New York Times story on Denmark Leads the Way in Digital Care, in which 77-year old patient Jens Danstrup talks about what it's like to be a telemedicine patient:

"You see how easy it is for me?" Mr. Danstrup said, sitting at his desk while video chatting with his nurse at Frederiksberg University Hospital, a mile away. "Instead of wasting the day at the hospital?"

He clipped an electronic pulse reader to his finger. It logged his reading and sent it to his doctor. Mr. Danstrup can also look up his personal health record online. His prescriptions are paperless -- his doctors enters them electronically, and any pharmacy in the country can pull them up. Any time he wants to get in touch with his primary care doctor, he sends an e-mail message.

All of this is possible because Mr. Danstrup lives in Denmark, a country that began embracing electronic health records and other health care information technology a decade ago.

Adoption of Electronic Health Records in the US
The Centers for Disease Control issues an annual survey on the use of electronic health records in physician's offices. Last year, partly bolstered by meaningful use incentives in the Affordable Care Act, use grew by 6%. Dr. Elliot King blogs on the EHR increase, noting that:

"In 2011, 57 percent of office-based doctors used electronic medical records/electronic health records (EMR/EHR), according to the CDC. That number compares to the 50.7 percent of physicians' offices using EMR/EHR's in 2010 and 48.3 percent in 2009."

Some physicians are also taking to telemedicine via Skype, FaceTime and other video conferencing services. In Doctors who Skype: Renegades or Heroes?, Jean Riggle looks at the pros and cons of video chat as used by physicians. She notes that there currently aren't any guidelines for electronic communication between physicians and patients and there there are several important questions yet to be solved:

• How can these chats be integrated into the patient's medical record?
• Can the actual video be captured and inserted into the record or should a summary of the call suffice?
• How should physicians be reimbursed for the time they spend using social media?

To follow developments in telemedicine, we offer a few sources:
HealthIT.hhs.gov
Federal Health IT programs
American Telemedicine Association
iHelathBeat
Healthcare IT News

Guinness is good for you - That's the news from Tinker Ready, who is hosting the Health Wonk Review: Wearing the Green for the St. Patrick's Day Edition at her blog Boston Health News. We think it's pretty fitting to have a Boston blog hosting this particular edition!

From the bizarre file - Thomas A. Robinson ofRisk Management Magazine offers a list of the 10 most bizarre workers compensation cases during 2011. Robinson rightly notes that, "Despite their unusual nature, however, one must always be respectful of the fact that while a case might be bizarre in an academic sense, it was intensely real, affecting real lives and real families." So true. We hope he'll follow with a collection of the 10 most bizarre employer acts - we've seen a few in our day.

OSHA whistleblowers - Just a reminder: Don't fire someone for reporting safety hazard. A Florida charter school is learning this lesson the hard way. OSHA is suing Manatee School for the Arts in Palmetto, Fla seeking reinstatement of the former employee with full benefits; payment of back wages, punitive damages, and compensatory damages, among other things.

New York's Reg. 194 - There's a big brouhaha in New York over N.Y. Reg. 194, with risk manager groups and agent groups coming down on opposite sides of the fence. N.Y. Reg, 194 is a broker-disclosure rule that requires agents to advise clients that they receive commissions from insurers. The ruling was proposed by the Division of Insurance in the aftermath of the Spitzer investigations against several large brokerage firms. Last week, a NY Appellate Court upheld the rule.

Exploding pig farms - We posted a link to this issue before - but the mysterious hog farm explosions continue to stump scientists. A strange, potentially explosive foam is surfacing near manure pits in about 1 ou tof every 4 hog farms, and has caused six explosions since 2009. According to the article: "This has all started in the last four or five years here. We don't have any idea where it came from or how it got started," said agricultural engineer Charles Clanton of the University of Minnesota. "Whatever has happened is new." The National Hog Farmer has more background: Foaming swine manure poses explosive risks.

Wellness focus - Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States, and the number one cancer killer in non-smokers. Why not issue a reminder to your employees: Colorectal cancer screening saves lives.

Market conditions - Roberto Ceniceros notes that captives are thriving as the work comp market hardens. Rising prices for traditional insurance vehicles always means that alternative insurance programs see growth.