The third meeting of the Workers’ Compensation Summit was held in New Orleans, LA on November 29th at the Morial Convention Center. It was graciously hosted by the National Workers’ Compensation and Disability Conference. This meeting, like the ones that preceded it in Orlando and Dallas, had its share of frustrations, but also produced what will come to be its defining highlights.

The 40 participants that gathered for the 5 hour meeting spent a great deal of time discussing bad actors in the workers’ compensation system. The subject of the talks ranged from outright fraudulent activities such as surgeons using counterfeit parts and “injury mills” recruiting workers for bogus claims, to the less obvious malevolent players whose actions include intentional delays in benefits as well as vendors pursuing profit without value in the rendering of services to the injured worker. It was a long and animated section of the meeting, and one that did not bring clear resolution to the issue. It was clear, however, that those acting with ill-defined and negligent intent are hurting people and stealing resources from the system, and we will need to spend more time focused on this issue in the future.

The group also spent more time discussing the Priority Issues originally identified at the first Summit meeting in Dallas back in May. The primary 3 out of the original 29 issues are Benefit Adequacy, Regulatory Complexity and Delays in Treatment for Compensable Claims. During this round in New Orleans, there were a couple very strong ideas presented and discussed that could have true potential for the industry.

This would be a good time to point out that, due to the makeup of the Summit, you will likely never see an official list of recommended actions from the group. This group is made up of players from all sides of workers’ comp, who have strikingly different views and opinions, mostly influenced and driven by the segment they work with and represent. Therefore, the possibility that 100% of participants will align behind a single recommendation is less than unlikely; that type of solidarity is just not going to occur. Still, there were ideas that got strong support from most participants without generating vociferous opposition in competing corners. These ideas will most likely be presented as “considered by the majority of Summit participants as viable for broader discussion and consideration”. 

Such is the way the wheels (slowly) turn within workers’ compensation.

We are crafting a report that will summarize Summit findings to date, and more detail will be provided within that document. I can briefly summarize two of the New Orleans generated ideas here. One of the ideas from the Summit was to look at a way of balancing indemnity benefits to better protect injured workers’ during the original and early phases of their injury, while at the same time focusing more intently on returning them to work and motivating their ultimate exit from the system. This concept can best be described as a “graduated indemnity schedule”. For Temporary Benefits, this would involve removing AWW caps on weekly benefits, so that workers’ in the initial throw of a severe injury would be better able to maintain their homes and financial integrity while they heal. Part of that effort would require a shift to payments on a post-tax, rather that pre-tax basis, and at a slightly higher percentage of AWW than is previously used in most states (say 80% instead of 66 2/3%). That would insure that higher earning workers would not see an increase in take home pay during an injury, but would also prevent them from losing their homes and financial health during an extended healing period.

As they shift to a permanent indemnity structure after a certain period of time, they would see a graduated reduction in indemnity benefits. This amount is to be determined, but for our example, let’s assume the reduction would be to 60% of the temporary benefit payment levels. Recognizing that workers’ comp is a safety net, and was never designed to fully maintain lost financial abilities, this graduated indemnity schedule would, in the words of one participant, “take care of the injured worker while they heal, while preparing them for a new economic reality from their situation”. This entire idea, of course, would be most effectively utilized in a system wholly geared to “workers’ recovery”.

Another very strong idea that percolated through the din was a method of benchmarking physicians to assure that top performers were identified and used within the system. There is a growing recognition within the industry that the decades long pursuit of the “cheapest doctor for the network” is anything but a grand bargain for the worker or the employer. Skilled physicians who can get results and help their patient heal quickly are worth their weight in gold, and deserve a commensurate compensation. One participant described how their company has developed a ranking, or benchmarking, system that is easy to understand (they are assigned one to five stars based on pre-defined criteria) so that adjusters can select those physicians known to be performing best in the interest of the injured worker. Getting the best medical care promptly is the fastest path to better results and reduced litigation. This was one of the strongest ideas to emerge in this meeting (IMHO), as it is easily replicable by other players in the industry.

We are in the process of developing a survey for Summit participants that will better define some of the points and ideas discussed at this meeting. A more detailed report will be available outlining these and other concepts discussed. One big positive to me was the participants desire to continue meeting, so we are assessing the best time and place for that continued effort.

Stand by. For better or worse, it appears the National Conversation of 2016 will live on another year….. 

Editor’s Note: Bob has issued an update to this post to clarify some misconceptions it may have caused. You may read that here.

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