State of the States September 2, 2022

Mental Health

Chicago based Rising Medical Solutions released its latest national report demonstrating that mental and social elements play a significant role in improving the claims process

NationalMental and social elements play a factor in the improved claims process, according to Rising Medical Solutions, based out of Chicago, IL. After utilizing several focus groups among employers, insurers, state fund and third-party administrators, Rising researchers concluded that "tackling societal health disparities and training frontline staff on psychological issues are among the key areas where the workers' compensation industry can improve." The study emphasized combatting the stigma of psychosocial issues and mental health conditions by pushing a focus on total worker health. Changes include considering societal factors outside the workplace, such as housing instability or food insecurity, and applying community resources necessary for injured employees with potential health disparities. Researchers noted that communication is a vital area of improvement essential to achieving positive outcomes; this includes verbally explaining claim decisions before sending "legalese" notifications. Advanced analytics and predictive models were also identified as an area of improvement. 

A new nationwide study from Enlyte shows signs that topicals are increasing in popularity and price

NationalA new report from Enlyte shows that topical costs may be on the rise. While opioid use continues to decline, the use of topicals is gaining appeal. From 2020 to 2021, topicals saw a near 5 percent increase in utilization; however, they remain less than 6 percent of workers’ compensation prescription drugs. Approximately 114 out of every 1,000 injured workers were prescribed topicals to manage varying severity of pain. Although a slight uptick in prescribing for topicals, some are concerned that drug costs for such prescriptions are inflated. According to Enlyte, the average topical costs $2,100 per script, comprising 12.3 percent of workers’ compensation drug spending. 

The U.S. BLS indicates that the highest risk states for non-fatal injury include Vermont, Maine, and Nevada. States for high risk of fatal injuries were Wyoming, Alaska, and South Dakota

NationalUsing data from the Bureau of Labor Statistics (BLS), Occupational Health & Safety Magazine identified non-fatal and fatal injury high-risk states and occupations. According to BLS data, Vermont, followed by Maine and Nevada, have the highest non-fatal injury rate per 100,000 workers. States with the highest fatal injury rate per 100,00 workers were Wyoming, Alaska, and South Dakota. Numbers also show that over 1,000 workers are fatally injured in the construction industry, ranking it the deadliest general industry. The transportation sector along with natural Resources and mining occupations, were also classified at extreme risk for fatal injury. BLS personnel indicate that Thursday is the most common day for fatal injuries and that most fatalities are in August, which is usually the hottest month of the year. 

Denver-based firefighters struggle to access the workers’ compensation system even with presumptions in place

injured-workers-pharmacy-blog-coloradoDenver-based firefighters are struggling to access cancer benefits despite state presumption laws on their side. In the last decade, 27 cancer claims have been accepted while 27 were denied, with four still pending. For those waiting to hear about their claim status, many wait 3-6 months and must utilize their own insurance to cover costs. The 2007 firefighter presumption statute, as written, permits certain cancers to be covered. These conditions include brain, skin, digestive, hematological, or genitourinary cancers. As listed, the cancer coverage is more comprehensive than most as the state describes bodily areas more broadly. However, the state presumption system remains a tumultuous barrier as the standard of proof for work-related cancer is hard to meet for many firefighters. In response, the legislature approved the Voluntary Cancer Award Program (VCAP), which allows cities and special districts to pay a premium to a statewide program. The VCAP is a one-time payout to those firefighters suffering from cancer with a lower burden of proof standards. Unfortunately, the VCAP payout is not as generous as workers' compensation and could leave firefighters with unexpected out-of-pocket expenses depending on the severity of their cancer. 

The Division of Workers’ Compensation (DWC) reports that claim frequency increased nearly a quarter likely due to the pandemic

TXThe Division of Workers' Compensation (DWC) reports that claim frequency increased nearly a quarter in the 28 months of the thick of the pandemic when compared to two plus years of data before the virus's spread. An uptick in claim frequency during the pandemic breaks a 20-year interrupted trend of decreased claim frequency in the Lone Star state. Carriers report over 90,000 claims being filed between March 2020 and August 7th, 2022. Over half of claims and fatalities included first responders and correctional officers. In total, DWC officials say there were 459 fatalities reported during the timeframe. The division indicated that it accepted around 59 percent of claims associated with a positive covid-19 test or formal diagnosis. Although 22,000 claims were denied, only 207 disputes were filed. Of covid claims, 65 percent involved indemnity-only payments. Of the 35 percent that included medical and indemnity benefits, 89 percent of payments went to hospital/facility payments, whereas outpatient services comprised just 8 percent. The report notes that almost a quarter of those who had covid claims accepted and received medical/hospital services experienced services beyond one-month post-injury. Approximately 10 percent received services such services for more than six-months post-injury. 

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