2019 CLM Workers Compensation Conference
Opening Session / Keynote - Bending the Curve: From Triple Aim to Prospective Analytics — The Future of Workers’ Compensation
The Triple Aim of improving the health of injured workers, reducing the per capita cost of healthcare and improving the patient care experience is the foundation for a value-based healthcare economy in Workers’ Compensation. With greater insight into analytics and more transparency among payers and providers, the future looks brighter for lower costs and better patient outcomes.
Premier Session 1: Riding the Green Wave— Navigating the Intersection of Medical Marijuana, Politics, Medicine and Workers Compensation
Jeremy Buchalski, Wilson Elser
Carlos Giron, Pain Institute of Georgia
Ronald A. Mazariegos, Arrowpoint Capital
Jeremy Unruh, PharmaCann LLC
2018 brought a slew of changes to medical marijuana landscape. With New York leading the charge in bringing medical marijuana to Workers Compensation, other states are following suit. While the grey area of the legality of medical marijuana still exists, more and more doctors, injured workers and legal authorities are starting to embrace this alternative treatment. This session will explore the most recent developments in medical marijuana and Workers Compensation with a particular emphasis on legal issues, legislation, the carrier’s perspective and real world practical solutions to dealing with medical marijuana as a form of treatment in Workers Compensation.Back to top
Session 1 - 50 Claims Hacks in 50 Minutes — Highly-Original and Creative Claims Tips
Katie Hensley, Cottingham & Butler
James Moran, Nyhan, Bambrick, Kinzie & Lowry, P.C.
Michael Navarra, Rivers Casino/Midwest Gaming Inc.
What do you do when an opponent attorney just will not call you back? How about sending them a certified envelope, but "forgetting" to insert the letter? We guarantee you will get a call. An attorney, two risk managers, and a broker with a combined 75+ years in the industry reveal their most original, effective, and often hilarious tips for the first time. This fact-paced discussion is highly-interactive and a bit irreverent.Back to top
Session 1 - A 360 Degree View of the Psychology of Catastrophic Claims — Litigation, Medical, and Risk Management Strategies
Julie Fawson, Paradigm
Brenna Hampton, Hanna, Brophy, MacLean, McAleer & Jensen
James M. Poerio, Poerio & Walter, Inc.
Stacy Whalen, Safety National Insurance
When catastrophic injuries, it is essential to identify a team with the right mindset. Each member of the team must orient their thinking in light of the particular nature of the injury. This presentation will focus on the psychology required of the defense team, including the handling claims professional, the carrier/ reinsurance professional, medical managers, and defense counsel. The defense team needs to be aware of their internal environment just as they need to be aware of the injured workers’ situation. The greatest cost efficiencies will be won through patience and perseverance, and will arise from an honest assessment of the injured worker to determine early on where the “tar pits” are in the case. Empathy for the injured worker has to be balanced by good business sense, but the two concepts are not mutually exclusive. Having the right mindset is crucial to overcoming the various challenges posed by a catastrophic injury claim.Back to top
Session 1 - Construction Site Accidents — The Factors Involved in Determining Liability
Marie Cheung-Truslow, Law Offices of Marie Cheung-Truslow
James A. Ruggieri, Higgins, Cavanagh & Cooney, LLP
Samuel Wordeman, ARCCA, Inc.
Mei Wright, CNA Insurance
According to OSHA, in 2016 over 21% of all work-related fatalities resulted from construction accidents. This presentation will cover why/how most construction site accidents occur and what factors are involved in determining liability for any claimed injuries. We’ll discuss incidents such as falls from elevations (ladders, scaffolding, roofs/leading edges, floor openings), falling objects, and same level falls (slips, trips), including case studies. We will also look at the engineering codes and standards and applicable labor law for different scenarios.Back to top
Session 1 - Using Data Analytics to Drive Performance
Bob Bowman, The Wendy's Company
Jayant Lakshmikanthan, CLARA Analytics
Chris Mandel, Self Employed
Duane Pifer, Willis Towers Watson
Workers compensation is intensely data driven, but data is only valuable when it is used to drive action centered on more informed-decision making principles. This session will take a very pragmatic look at the decision-making tools available to workers compensation professionals. The discussion will begin with an identification of key sources of data. This will be used to set the stage for showing how to transform existing information into action. Speakers will also look at data analytics and illustrate how past data can help explain what happened and why. The session will also address predictive modeling and show how data in the past can be used to predict the future. Speakers will also address artificial intelligence, machine learning, and automation.Back to top
Session 1 - Workers Comp in the Age of Technology
Cliff Belliveau, myMatrixx
Matthew Condon, Bardavon Health Innovations
Jennifer Morris Jones, Cranfill Sumner LLP
Caryn Siebert, Gallagher Bassett Services, Inc.
Technology is no longer a novel concept, it is ingrained as an aspect of everyday life both at work and at home. From activity trackers and smart watches, to hydraulic prosthetics and stimulators, employees and employers are using technology in unprecedented ways. This presentation will include an overview of legal and medical breakthroughs along with challenges and strategic management of technological utilization in workers compensation claims. Specifically, it will focus on how technology can be used to monitor employee performance and safety, enhance post-injury care, and create additional opportunities for employees to return to work. We will also examine various issues and barriers, such as privacy, from both the employer and the injured worker point of view.Back to top
Session 2 - Caring for the Total Worker
Michael Choo, Paradigm
Robert Doherty, Evans & Dixon, LLC.
Melissa Dunn, Self Employed
Lindsay Huffman, Amerisure Mutual Insurance Company
The presence of a mental health condition predicts a longer duration of work absence. Successful treatment and return to work require a skilled interdisciplinary team working with a biopsychosocial approach to address the injured worker’s entire condition. This session will discuss the most effective model of care, which incorporates injured worker and physician engagement, consistent use of evidence-based medical guidelines, and multidisciplinary treatment managed by diagnosis clarification, coordinated care and informed monitoring interventions.Back to top
Session 2 - Maximizing the Productivity of an Aging Workforce
Baby boomers are reaching retirement age and many are electing to continue working. Their reasons range from enjoyment and desire to stay active to economic struggles resulting from declining home values, low returns on 401k plans, or rising healthcare costs. This demographic shift is forcing companies to change the way they think about their workforce strategies including their workers compensation and disability programs. Older workers have much to offer in terms of their knowledge and experience. However, they come with a unique set of risks. In order to capitalize on the productivity and capabilities these aging workers have to offer, employers must recognize some of the age-related changes that these people undergo — such as deteriorating eyesight, hearing, flexibility, strength, balance, and reaction times. Workplace accommodations can be made to retain this experienced talent pool. This panel will examine some of the changes workers go through as they age, how these factors affect their performance and productivity, and ways to mitigate any declines and accentuate opportunities for improved productivity.Back to top
Session 2 - Medical Directors’ Discussion of the Next Medication Crisis
Tron Emptage, Optum
Heidi Hanna, Auto-Owners Ins. Co.
Marcos Iglesias, Travelers
Jill Rosenthal, Zenith Insurance Company
While the opioid epidemic continues, and there’s still work to do, we are making strides in the battle to control opioid utilization and its overall cost toward a claim. We also know that opioids are not the only medications that increase risks and costs in claim management. So what’s next? What’s our next battle? This session will gather several managed care executives for an open discussion on the changing tides of medications and treatments in workers compensation. From specialty medications and alternative therapies, to compounds and weaning and tapering programs, they will provide insight on what they are seeing and where we need to expand our focus in 2019 and beyond.Back to top
Session 2 - Mitigation of Medicare Settlement Risk and Costs Through Clinical and Pharmacological Controls
James Anderson, Cattie & Gonzalez
Rajiv Das, MD, Safeway Inc.
Robert J. Finley, Hinshaw & Culbertson LLP
Rafael Gonzalez, Cattie & Gonzalez
Whether you are submitting your Medicare Set Aside (MSA) to CMS for approval or not, mitigating your Medicare settlement risk and costs through clinical and pharmacological controls makes sense. There are a number of steps an employer/carrier/third party administrator can take to mitigate such risk and reduce costs.Back to top
Session 3 - #RiskManagementIsWatchingYou - Tweeting, Hashtagging, and SnapChatting through the Trove of Social Media Avenues
Amanda Persicketti, Corvel Corporation
Michael Petrie, Social Detection
Wendy Smith, Morgan & Akins, PLLC
Linda Youngerman, Lockton Companies, LLC
The explosion of social media and technology is constantly creating new challenges for customers, insureds, risk managers, insurers, and TPAs in terms of privacy and confidentiality. Social media has also created new channels of communication for the insurance community to discover fraudulent claims. This session will explore how successful social media investigations have been in reducing fraudulent claims, new tactics of tapping into social media and the future of social media in risk management and claims. We will also discuss the potential risks associated with releasing seemingly confidential information, and the new legal struggles in proving insurance fraud in workers compensation cases.Back to top
Session 3 - Disaster Recovery in Workers Compensation
Lisa Anne Bickford, Coventry
Mark Lechowicz, Gallagher Bassett Services, Inc.
G. Steven Murdock, IFMK Law, Ltd.
Jennifer Wolf , International Association of Industrial Accident Boards and Commissions (IAIABC)
The hurricanes, flooding, and wildfires seen during 2017 and 2018 have forced the workers compensation industry to reexamine what should be done to aide claimants, providers, and stakeholders affected by natural disasters. Hear about Texas’ regulatory response to Hurricane Harvey, as well as California’s approaches to disaster planning and response. This presentation will also discuss work-related injury considerations before and after a disaster strikes, ideas for strategic disaster planning, and regulatory considerations during disaster recovery.Back to top
Session 3 - Initial Intake to Final Settlement – A Blue Print for Your Workers Compensation Catastrophic Claim
Amy E. Bilton, Nyhan, Bambrick, Kinzie & Lowry, P.C.
Beth Hostetler, Albertson's LLC
Denise Segovia , Acuity Insurance
Paul Sighinolfi, Ametros Financial Corporation
Kathleen Wyeth, AF Group
A catastrophic workers compensation claim is devastating for both the claimant and the claimant’s family. The management of such claims also requires a high level of expertise on the part of the claims handlers. Join our lively, veteran panel as we go through case examples and address the various touch points where the claim handler’s decisions will have the greatest impact on the ultimate resolution of the claim. Our panel’s comprehensive analysis will include best practices for the defense of the claim and provide various options for giving Medicare’s interests reasonable consideration in the settlement. Learn about alternatives to the traditional CMS-approved MSA such as the Compromise MSA, Evidence-Based Medicine MSA, and MSA Legal Opinion. Conditional payment resolution techniques and tips will also be discussed as well as tips for the identification of Medicare Part C and D plan claims. This session will also delve into the administration options for management of future medical funds, Social Security disability offsets, and Special Needs Trusts. Attendees will leave the session well versed in techniques to assist in the claims handling of a catastrophic workers compensation claim from initial intake to final settlement.Back to top
Session 3 - That Can't Be Right! - Addressing Controversial Diagnoses and Treatments
Robert J. Barth, Barth NeuroScience
Gregory McKenna, Gallagher Bassett Services, Inc.
William Pipkin, Austill, Lewis, Pipkin & Maddox, P.C.
Controversial diagnoses such as fibromyalgia, neuropathic pain, CRPS/RSD, and post-concussion syndrome create challenges for all involved. The clinical standards for medical causation are receiving closer scrutiny and the spread of objective medical guidelines is providing a broader range of tools for claims professionals and lawyers. Learn how to harness the latest clinical research and use objective diagnostic protocols to gain the leverage needed to eliminate or mitigate controversial medical diagnoses. Learn how to identify and respond to requests for controversial treatments that remain standard practice despite the fact that research shows they do not improve outcomes and will likely do more harm than good. Hear about outcome-based approaches involving ancillary providers. Participate in a discussion about how to advocate treatments that are not only more cost effective for the employer/carrier but are more likely to result in better outcomes and improved function for the injured worker.Back to top
Session 3 - Ways to Positively Affect Workers Compensation Claim Outcomes
Suzanne McTeague, Sedgwick
Thomas Ryan, Self Employed
Michael Sullivan, Michael Sullivan & Associates
Workers compensation remains the grand bargain between injured workers and employers today. However, it is not without its blemishes, and many stakeholders continue to look for ways to improve this state-driven, statutory system. There is much speculation around newly adopted or pending state legislation and what impact these laws and regulations will have on the injured worker. Similarly, employers are continually reviewing, approving, and implementing new organizational programs and initiatives. While both of these avenues may ultimately prove to be effective, some will take time to produce results. Regardless of these longer-term legislative discussions or employer initiatives, it is important to consider the current needs of injured workers and place their well-being at the center of all claims activities. There are a number of steps that can positively affect outcomes for the injured worker and the employer. This session will share proven and practical strategies and tactics designed to achieve improved claims results.Back to top
Session 4 - Aggressive Claims Handling
Steve Carman, Celadon Trucking
Judith Cole, K2 Industrial Services, Inc.
Kirsten Kaiser Kus, Downey & Lenkov LLC
Claire Muselman, Self Employed
Leslie Rodgers, Cincinnati Insurance Company
Join our experienced panel to discuss ways to aggressively move and close your claims throughout all phases of litigation. We will address key strategies for what to do in the first 48 hours of notification of a claim, bold investigation techniques, ways to move injured employees to a medical release in an efficient manner and how to craft settlements by using the evidence to your best advantage.Back to top
Session 4 - Innovative Structured Settlement Programs with Improved Metrics and Analytics
The structured settlement market continues to change dramatically. Without innovative metrics and analytics to update and align company programs, claims executives and staff are unlikely to achieve related operating efficiencies. This panel will use recent studies to highlight current discontinuities and opportunities for immediate operational improvement and "safe-harbor" governmental compliance.Back to top
Session 4 - Maximizing the Value of Medical Care with Advocacy Programs
Andrea Buhl, Sedgwick
Darin Hampton, International Paper
Brian Palmer, Alliant Insurance Services, Inc.
The medical care and recovery environment of an injured worker largely determine the outcome of the claim. Effectiveness is driven by how quickly care is administered and the appropriateness of the treatment that is provided. Recovery is also dependent upon claims philosophy, employee engagement, co-morbidities, psycho-social issues, and pain management. Employers are placing less emphasis on cost reduction and more emphasis on injured worker experience using empathy and advocacy techniques. Advocacy is a concept that has been introduced in recent years as a way to reduce claims costs and improve the overall claims experience. While taking many forms, advocacy programs are rooted in making the injured employee a priority and showing concern for the individual’s overall health and well-being. Advocacy proponents claim that this approach not only improves injured worker satisfaction, but can also create financial dividends by reducing litigation rates, medical costs, and claim durations. The session will provide a practical, in-depth look into leading advocacy programs and their resulting performance.Back to top
Session 4 - PTSD Claims from First Responders
Brad Gronke, Gallagher Bassett Services, Inc.
Rich Lenkov, Downey & Lenkov LLC
Alexander Obolsky, Health and Law Resource, Incl
Employers are increasingly responding to drug overdoses, assaults, shootings and other traumatic events. Are those claims always compensable? What are the practical issues dealing with such claims? This panel of workers’ compensation professionals will give you real world takeaways for dealing with this complex issue.
Session 4 - Workers Compensation Pain Management Alternatives
Sherie Gekiere, Amerisure Mutual Insurance Company
Shana Margolis, M.D., Shirley Ryan Ability Lab
Paul Peak, Sedgwick
Kim Pfingstag, International Paper
The opioid epidemic in the U.S. has led the industry to rethink pain management and assess response to injured workers. Most experts will agree that long-term opioid use is not an effective pain management solution and does not substantially improve an injured worker’s function over time. In many cases, the pain of an injury drives medical treatment, increases disability duration and extends time away from work. Ultimately, the injured worker continues to suffer and often does not attain the optimal quality of life and level of productivity desired. Today, risk managers, claim professionals, medical experts, and pain specialists are beginning to collaborate and put forth alternatives to pain management using a multi-disciplinary approach with an emphasis on putting the injured worker’s interests and well-being at the forefront. In this session, speakers will look at issues such as how to get in front of pain; ways to improve patient understanding of pain components; the importance of employee engagement; and alternative pain management treatments including yoga, meditation, acupuncture, and behavioral therapy treatments.Back to top
Premier Session 2: Medical Devices that Fail
Genese Dopson, Self Employed
Julie Fortune, Self Employed
Jeanne Lenzer, Jeanne Lenzer, LLC
Giovanni Masucci, National Digital Forensics, Inc.
Workers Compensation claimants with medical devices are generally pain pumps or spinal cord stimulators. Other devices might include orthopedic implants or devices to assist in the bathing or transfer/lift of those who are immobilized.
Modern medicine has given us countless devices to improve our quality of life. From internal implants to external braces and prostheses, these medical devices sometimes are necessary to conduct normal lives. However, these devices sometimes fail without warning.
When an implanted medical device fails, the solution often involves another painful and expensive surgical procedure. Other non-implanted medical devices, such as back and knee braces or artificial limbs, can also fail, resulting in further injury.
Session 5 - Dealing with Legal Marijuana and Its Effect on the Workplace
Lisa Brennan, Markel Service, Incorporated
Toni Herwaldt, Navistar, Inc.
Stella Skaljac, Self Employed
Myra Barsoum Stockett, Self Employed
This panel will discuss the evolving statutory and case law guidance for employers in states where medical and/or recreational marijuana has been legalized. This will include issues relating to disability accommodation, hiring/firing, drug testing, workplace safety, and the defense of workers compensation claims based upon intoxication. Must medical use be accommodated? Can employment decisions be based on cardholder status or a positive test for legal use? Can a positive post-accident test be used to defend a workers compensation claim? These questions will be addressed based on currently available legal authority.Back to top
Session 5 - Effectively Refuting Medicare Conditional Payments
Jay Gates CPCU,ARM, AIC , Arthur J. Gallagher & Co.
Melissa Icban, ARM, Sedgwick
Patrick Sodoro, Sodoro Law Group
Steven Tipton, Flahive Ogden & Latson
Recently the workers compensation payer community has been inundated with conditional payment notices and demands for a barrage of older claims, many for injuries dating back to the 70s and 80s. This comes on the heels of the implementation of Mandatory Insurer Reporting, which began back in 2011, but has only recently begun generating this level of activity. Larger self-insureds and carriers have received overall payment demands totaling in the millions. The panel will lead a discussion on this significant issue.Back to top
Session 5 - Employment Nightmares — The Intersection of Workers Compensation, FMLA, and ADA
Learn how small employment decisions can have big impacts on successful resolution of workers compensation claims. Top tips for the interaction of counsel, claims professionals, and the employers, including avoiding subsequent FMLA leave interference, disability discrimination, and retaliation claims, and strategies for separating high-risk claimants.Back to top
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