Things you should know

NSC offers free toolkit to fight opioid abuse

The National Safety Council (NSC) is offering a free toolkit to help employers address the opioid crisis. The Opioids at Work Employer Toolkit addresses warning signs of opioid misuse, identifying employee impairment, strategies to help employers educate workers on opioid use risks, drug-related human resources policies, and how to support employees struggling with opioid misuse.

Workplaces most common site of mass shootings: Secret Service report

In its second Mass Attacks in Public Spaces report, the Secret Service examined 27 incidents in 18 states that involved harming three or more people. Most occurred in workplaces (20) and were “motivated by a personal grievance related to a workplace, domestic or other issue.”

Worker participation key to preventing safety accidents: CSB

The U.S. Chemical Safety Board (CSB) published a new safety digest discussing the importance of worker participation to avoid chemical mishaps. The report outlines how the shortage of worker engagement was a factor in various incidents examined by the CSB.

2018 guidelines more effective in preventing carpal tunnel: NIOSH

Previous studies showed that the 2001 American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value (TLV) for Hand Activity was not sufficiently protective for workers at risk of carpal tunnel syndrome (CTS) and led to a revision of the TLV and Action Limit in 2018. A new study compares the effectiveness of the 2018 and 2001 guidelines, concluding that the 2018 revision of the TLV better protects workers from CTS.

NIOSH notes that many workers are exposed to forceful repetitive hand activity above the guidelines and urges compliance with the updated guidelines.

First aid provisions in workers’ compensation statutes and regulations: NCCI

The National Council on Compensation Insurance, Inc. (NCCI) has compiled state statutes and regulations related to First Aid in Workers’ Comp. The document does not include review or analysis of the statute or regulation, of relevant caselaw, or other guidance and is subject to change.

Mandatory treatment guidelines may lead to fewer back surgeries

States with mandatory use of medical treatment guidelines in utilization review, reimbursement and dispute resolution may lead to lower rates of lumbar decompression surgery among workers with low back pain, according to a new report by the Workers Compensation Research Institute.

The 27 states in the study include Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

Engineered-stone fabrication workers at risk of severe lung disease

Exposure to silica dust from cutting and grinding engineered stone countertops has caused severe lung disease in workers in California and three other states. The CDC released information on cases in Washington, California, Colorado and Texas in an article published in the agency’s Morbidity and Mortality Weekly Report. According to the article, 18 cases of silicosis were identified in the four states from 2017 – 2019. Two of those workers died from the illness.

Campbell Institute offers a guide on how to get started with leading indicators

An Implementation Guide to Leading Indicators is intended to help employers initiate the process when implementing leading indicators for the first time.

Annual wind energy safety campaign focuses on hands

The American Wind Energy Association will offer several free resources in October as part of its annual month-long safety awareness campaign aimed at helping protect renewable energy workers from on-the-job injuries. The theme of the 2019 campaign is Take a Hand in Safety: Protect These Tools.

NIOSH releases international travel planner for small businesses

The 36-page travel planner is a new resource intended to help small-business owners ensure the health and safety of employees who travel internationally.

State News

California

  • Governor Newsom has signed two bills relating to workers’ comp. A.B. 1804 will require the immediate reporting of serious occupational injury, illness, or death to the Department of Industrial Relations’ Division of Occupational Safety and Health. A.B. 1805, modifies the definition of “serious injury or illness” by removing the 24-hour minimum time requirement for qualifying hospitalizations, excluding those for medical observation or diagnostic testing, and explicitly including the loss of an eye as a qualifying injury for the new reporting requirements. Both bills will take effect Jan. 1, 2020.
  • Legislators approved a landmark bill that requires companies like Uber and Lyft to treat contract workers as employees. The Governor is expected to sign it after it goes through the State Assembly. Uber, Lyft, and DoorDash have vowed to fight it.
  • Insurance Commissioner Ricardo Lara approved the Workers’ Compensation Insurance Rating Bureau’s annual regulatory filing that will, among other things, lower the threshold for experience rating.
  • The Division of Workers’ Compensation (DWC) announced that the temporary total disability rate will increase 3.8% next year, not more than 6% as the agency previously announced.
  • The DWC has issued an order modifying its evidence-based treatment guidelines for work-related hip and groin disorders. Effective October 7, 2019, the changes involved two addendums to the workers’ compensation medical treatment utilization schedule and incorporate the American College of Occupational and Environmental Medicine’s most recent hip and groin disorders guidelines.
  • The DWC launched an updated free online education course for physicians treating patients in the workers’ compensation system.

Illinois

  • Beginning July 1, 2020, hotels and casinos will be required to have anti-sexual harassment policies that include, for certain workers, access to a safety button or notification device that alerts security staff under the newly created Hotel and Casino Employee Safety Act.
  • Gov. J.B. Pritzker signed legislation requiring freight trains operating in the state to have at least two crew members, challenging the Federal Railroad Administration’s recent effort to prevent states from regulating train crew sizes. Scheduled to go into effect January 1, 2020, S.B.24 is to be known as Public Act 101-0294.

Minnesota

  • Department of Labor and Industry has posted new workers’ compensation medical fee schedules that took effect Oct. 1. The schedules update reimbursement for ambulatory surgery centers, hospital inpatient, and outpatient services, and provide new resource-based relative values for providers.
  • The workplace fatality rate in Minnesota grew to 3.5 per 100,000 full-time workers in 2017, the highest rate in at least a decade, according to new data from the Safety Council. Almost one in three fatal workplace injuries involved driving a vehicle.

North Carolina

  • The Industrial Commission announced that the maximum for temporary and permanent total disability will go from its current level of $1,028 to $1,066, starting Jan. 1.

Pennsylvania

Tennessee

  • New rules for medical payments went into effect September 10, 2019. Not only are reimbursement rates increasing for providers and hospitals, but the conversion factor may now “float” or follow Medicare’s changes, rather than being fixed.
  • The NCCI is recommending a 9.5% decrease in loss costs for the voluntary market in 2020, a figure that’s half of what the rating organization recommended for this year.

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com

Things you should know

Studies and reports:

The Relationship of the Amount of Physical Therapy to Time Lost From Work and Costs in the Workers’ Compensation System – Journal of Occupational Medicine

Finding: Injured workers who take time off work to recover, and whose treatment includes more than 15 sessions of physical therapy, are out of the workforce longer and are six times more likely to cost more.

Suicide and drug-related mortality following occupational injury – American Journal of Industrial Medicine

Finding: Workplace injury significantly raises a person’s risk of suicide or overdose death.

Fatal occupational injuries to independent workers – BLS

Finding: Fatalities among independent workers accounted for about 12% of all workplace deaths in 2016-2017, and independent workers have a disproportionately higher share of fatalities due to falls, slips and trips.

Interstate Variations in Dispensing of Opioids, 5th Edition – Workers Compensation Research Institute (WCRI)

Finding: In 27 states, fewer injured workers received opioids recently as compared with previous years. But, injured workers continue to be treated for pain, as non-opioid pain medications (e.g., NSAIDs) increased to a lesser degree and non-pharmacologic treatments (e.g., physical therapy) without pain medication were more frequently provided.

The effects of sleep on workplace cognitive failure and safety (Construction) – Oregon Healthy Workforce Center

Finding: Among construction workers, there is a connection between poor quality sleep and the risk of workplace incidents and injuries.

Calories Purchased by Hospital Employees After Implementation of a Cafeteria Traffic Light-Labeling and Choice Architecture Program – Massachusetts General Hospital

Finding: Implementation of a traffic light-labeling and choice architecture program was associated with a 6.2% decrease in calories per transaction over 2 years, including a 23.0% decrease in calories from the least healthy food.

Drug trends: Evaluating Opioids – Coventry

Finding: The prescribing of drugs meant to treat opioid use disorder increased 5.4% in 2018 among workers compensation claims and 1.8% of claims with high doses of opioids received naloxone – an anti-overdose medication – at almost double the amount from 2017.

2019 RIMS Benchmark Survey – Business Insurance

Finding: The average total cost of risk for businesses rose by 2.1% in 2018, reversing four years of declines.

Workplace Secondhand Tobacco Smoke Exposure Among U.S. Nonsmoking Workers, 2015 – CDC

Finding: Nearly 1 out of 5 workers are exposed to secondhand smoke on the job. Results identify industries most at risk.

Commercial motor vehicle brake inspection event set for Sept. 15 – 21

Commercial motor vehicle inspectors throughout North America will perform brake system examinations Sept. 15-21 during the Commercial Vehicle Safety Alliance’s annual Brake Safety Week. While special emphasis will be placed on brake hoses and tubing, inspectors also will be looking for other critical non-brake-related violations.

State News

California

  • The Workers Compensation Insurance Rating Bureau (WCIRB) proposed that the Jan. 1, 2020 rates be about 5.4% lower than the current advisory pure premium rates, or $1.58 per $100 of payroll.
  • WCRIB’s X-Mod estimator is now available for 2020 at https://www.wcirb.com/estimator.

Florida

  • National Council on Compensation Insurance (NCCI) filed a proposed 5.4% rate decrease with the Florida Office of Insurance Regulation, effective January 1, 2020.

Minnesota

  • The Department of Labor and Industry has adopted an expedited rulemaking process, and has published new rules governing treatment and compensation for post-traumatic stress disorder in first responders.

Missouri

  • Department of Labor and Industrial Relations has adopted several new rule changes regarding administrative law judges, review applications and more.

Nebraska

  • Hospitals, insurers, self-insured employers, risk-management pools and third-party administrators can now make reports electronically. FAQ’s are on the website.

Virginia

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com

The daunting challenge of maintaining a drug-free workplace

With a national opioid crisis that defies holistic solutions, the legalization of medicinal marijuana in more than 30 states and recreational marijuana in 10 states, increases in deadly overdoses in the workplace, changing state laws, confusion over OSHA’s anti-retaliatory drug testing rule, and concerns about medical privacy, no employer should think they are immune to the problem. In fact, according to the National Safety Council (NSC), 15.6% of American workers live with a substance disorder and The Hartford reports that 64% of HR professionals are ill-prepared to help a worker with an opioid addiction.

These factors, coupled with a tight labor market and low unemployment, have led some employers to soften zero-tolerance policies for jobs where safety is not critical and there is a low risk of injury or error. The decision to relax zero-tolerance policies requires buy-in from company leadership and supervisors as well as serious evaluation of the consequences. Although the legalization of marijuana exponentially increases the complexity of the issue, the reasons for maintaining a drug-free workplace remain constant: safety of employees and customers, lower absenteeism, reduced turnover, fewer workers’ comp claims, fewer workplace conflicts, and reduced liability for workplace accidents.

It’s also troublesome for supervisors because substance abuse often falls below the radar of the workplace. Yet, for five consecutive years, unintentional workplace overdose deaths have increased by at least 25%. Drug testing, which is often a critical component of a zero-tolerance policy, can identify those at risk.

Here are five things to consider when evaluating a drug policy:

Legal concerns

While federal law regulating drug testing affects some heavily-regulated industries, there is no comprehensive federal law regulating drug testing in the private sector. The Drug-Free Workplace Act of 1988 requires all recipients of federal grants and some federal contractors to maintain a drug-free workplace.The ADA does not consider drug abuse a disability and allows drug testing; however, disability discrimination is a significant legal risk. If an applicant is not hired or an employee is terminated because of a positive drug test and the medication was legally prescribed for a disability, the employer could be liable. Reasonable accommodations must be provided at application, hiring, and during employment.

State laws that do regulate workplace drug testing vary widely and are constantly changing. Generally, state laws allow employers to drug test job applicants. However, many have rules about providing notice, preventing discrimination, and following procedures to prevent inaccurate samples. The laws governing testing of current employees varies widely by state, with some prohibiting random testing and others requiring ‘reasonable suspicion.’ There are also laws governing post-accident testing. It’s critical to understand and stay abreast of the laws in all the states in which you operate.

Marijuana

Marijuana is one of employers’ biggest worries and one of the driving reasons for employers to relax pre-employment drug testing. There is legitimate fear that it will reduce the pool of qualified candidates. Some address this issue by removing marijuana from the test panel for many positions that are not safety-critical.

The laws vary significantly with states that have legalized marijuana and case law is limited and evolving. Some states have card holder anti-discrimination statutes and some states prohibit firing of an employee who tests positive for marijuana while others allow it. Although all marijuana use is still illegal under federal law, state courts across the country are deciding cases on medical marijuana use and accommodation. Employers are wise to consider whether positive drug tests are connected to medicinal use before making employment decisions.

Employers should be careful about penalizing employees for off-duty marijuana use, since some states have statutes protecting employees. However, most states permit employers to prohibit marijuana use on their premises and to discipline employees who come to work under the influence.

While the uncertainty is unnerving for employers, a growing number of states are writing statutes to remove the ambiguities. Statutes in Arizona, Arkansas, Connecticut, Delaware, Illinois, Maine, Massachusetts, Minnesota, Nevada, New York, Pennsylvania, Rhode Island, Washington DC, and West Virginia address employment protection for medical marijuana patients. It’s still possible to restrict marijuana use in these states, but care needs to be taken in crafting and enforcing a policy.

If you choose to differentiate marijuana policies from other drug policies, consider these questions:

  • Will treating marijuana differently create problems in the workforce?
  • Under what circumstances will employees be tested for marijuana?
  • What are the consequences of not testing (i.e. more injuries, absenteeism)?
  • What is the process to determine a medical exception to the policy?
  • What happens when an employee fails the test?

Workers’ Comp

Substance abuse can contribute to workplace accidents and a drug-free workplace helps prevent accidents, thus lowering workers’ comp costs. In some states, employers implementing a drug-free workplace receive a premium discount. As of October 2018, 13 states had such laws. While the requirements and discounts vary, the states include Alabama, Arkansas, Florida, Georgia, Idaho, Kentucky, Mississippi, Ohio, New York, South Carolina, Tennessee, Virginia, and Wyoming.

In addition, some states have enacted laws to make it easy for employers who properly drug test to deny workers’ compensation benefits. For example, Florida law provides that if the employee tests positive for drugs, then “it is presumed that the injury was occasioned primarily by…the influence of the drug upon, the employee.”

Medical marijuana raises thorny issues for employers. Can a claim be denied if an employee tests positive for using state-approved medical cannabis? Can an injured employee receive medical marijuana to treat a workplace injury? Both are new and evolving issues that will be the subject of future court cases and state regulations. The Minnesota Department of Labor & Industries issued rules allowing cannabis as a reimbursable form of medical treatment.

OSHA

The anti-retaliatory provisions of OSHA’s e-Recordkeeping rule resulted in considerable confusion about post-injury drug testing policies, which was somewhat clarified in a guidance memo in October 2018. Before doing post-accident drug testing, employers should:

  • Have a reasonable basis to conclude drug use could have contributed to the injury
  • Test all employees whose conduct could have caused an accident, even if they were not injured
  • Identify high hazard work as a reason for testing
  • Determine if the drug test can provide insight to the root cause of incident
  • Consider whether drug test is capable of measuring impairment at the time the injury occurred
  • Ensure employees are not discouraged or dissuaded from reporting injuries

Remember, the rule does not affect new hires, random testing, or testing to comply with state or federal laws or required by Workers’ Comp insurers.

Privacy

Although challenges to workplace drug testing policies on the grounds that they violate employees’ privacy have generally not been successful, the manner in which the test is conducted and how the results are used have been successfully challenged. Drug test results are considered protected health information and must be kept confidential. Further, as laws on employee privacy continue to evolve, testing that is not clearly authorized by law could be open to legal challenges.

Conclusion

Zero-tolerance policies are strong stands that send an important cultural message, but like any policy it should be evaluated periodically. How effective has it been? Has it hampered recruitment and retention efforts for positions that are not safety-critical? Has it prevented workers from seeking the help they need to deal with substance abuse? Does it impede flexibility?

Anecdotally, more employers are tailoring drug testing to the job and adding a fitness-for-duty component. Any policy changes require serious consideration as protecting employees remains the top priority. However, no change in policy should excuse an employee who is impaired while working. There’s just too much at risk.

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com

Things you should know

Updated Workers’ Compensation Medicare Set-Aside Reference guide issued

The updated guide, version 2.9, addresses spinal cord stimulators and the inclusion of off-label prescription drugs, particularly Lyrica as well as updating Life Tables and examples of settlements not meeting The Centers for Medicare & Medicaid Services (CMS) review thresholds, but which would still require consideration of Medicare’s interests.

The NGHP User Guide was also updated and CMS will maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibly for medicals.

Some experts suggest that the changes are another indication that CMS intends to make Medicare Secondary Payer (MSP) enforcement a priority in 2019.

New app can help determine what’s allowed in MSAs

The CMS launched its “What’s Covered” app to give consumers more information about their Medicare benefits. It also can be a valuable assist for injured workers with MSAs.

Study: Most manufacturing workers experience fatigue

study by the American Society of Safety Professionals suggests that the automation of manufacturing processes may be contributing to worker fatigue, which was found in 58% of the workers studied. Fatigue monitoring, such as wearables that monitor heart rate, are a possible solution. The report also notes three interventions to help mitigate fatigue: posture variance, chemical supplements and rest breaks.

Work comp insurers cite top concerns

Every year for the past decade, the National Council on Compensation Insurance (NCCI) surveys carrier executives in the workers’ compensation industry to better understand their market perspectives, needs, and challenges. Learn what keeps them up at night.

New guidance for pain management in the age of the opioid epidemic

draft report from the Pain Management Best Practices Inter-Agency Task Force, which acts in an advisory capacity for the federal government, calls for individualized, patient-centered pain management. Public comments are welcome.

Study: Injured workers in the mining and construction industries and those in rural areas more likely to receive opioid prescriptions

study by the Workers Compensation Research Institute (WCRI) found 33% of injured workers employed in mining and 29% in construction received opioids for certain injuries and are more likely to receive higher doses and for longer time periods. The study also found that older workers were more likely to receive opioid prescriptions compared with younger workers, with 49% of injured workers age 49 or older receiving opioids compared to 42% of workers between the ages of 25 and 39.

Meanwhile, a higher percentage – 66% to 79% – of workers who sustained fractures, carpal tunnel and neurologic spine pain received at least one opioid prescription for pain relief. It’s postulated that those in rural areas receive more opioids because there are fewer pain management options available.

New video on performing tower modifications

new video from the National Association of Tower Erectors highlights the importance of understanding and following the proper sequence of performing tower modifications.

Injured Massachusetts teen workers lacked health and safety training: report

Nearly half of the teen workers in Massachusetts who were injured on the job between 2011 and 2015 said they did not receive health and safety training from their employer, according to a Massachusetts Department of Public Health annual report on teen worker safety. Four industries – accommodations and food service (37 percent), retail trade (19), health care and social assistance (11), and construction (4) – accounted for more than 70 percent of all work-related injuries involving teens in the state.

NIOSH releases resources on dampness and mold assessment

NIOSH recently introduced checklists to help employers assess damp areas and identify mold. The Dampness and Mold Assessment Tool has two versions – one for general buildings and one for schools – as well as a four-step assessment cycle.

CPWR releases alert, toolbox talk on lightning safety

Stressing the importance of lightning awareness while working outdoors, the Center for Construction Research and Training (CPWR) has published a hazard alert and toolbox talk addressing the topic.

State News

California

  • Division of Workers’ Compensation has updated its formulary for injured workers to include drugs to treat traumatic brain injury, effective Feb. 15
  • FMCSA granted a petition to pre-empt the state’s meal and rest break rules for commercial motor vehicle drivers

Florida

  • OSHA resumes normal enforcement activity following Hurricane Michael

Massachusetts

  • A new law applies OSHA standards to all public employees, including municipal workers and quasi-public agency workers

Michigan

Minnesota

  • New law recognizes post-traumatic stress disorder as a compensable condition for first responders

New York

  • Governor vetoed bill that would have regulated and permitted acupuncturists to treat injured workers in the state’s workers compensation
  • WC Board launches virtual hearing app, WCB VHC, which is free in the iOS App Store

For Cutting-Edge Strategies on Managing Risks and Slashing Insurance Costs visit www.StopBeingFrustrated.com