The LexisNexis Workers' Compensation Law Community is proud to sponsor the awards for Workers' Compensation Notable People for 2010.
These exceptional people have worked tirelessly on behalf of their clients and have made significant contributions this past year to the workers' compensation system and/or the workplace.
The recipients of the 2010 awards were selected by LexisNexis with feedback from various organizations and experts in the field, including the Workers Injury Law & Advocacy Group (WILG), the National Workers’ Compensation Defense Network (NWCDN), the Work Comp Analysis Group on LinkedIn, and selected members of the Larson's National Workers' Compensation Advisory Board.
This list is by no means complete. The LexisNexis Workers' Compensation Law Community encourages you to post a comment, telling us who you would've nominated for 2010 and why they deserve to be recognized by our web community.
Workers’ Compensation Notable People for 2010
Richard A. Sadow, Esq., founded the Friends of 440 Scholarship Fund in 1991 and has been its sole president. As a workers’ compensation attorney, he started the organization so that other attorneys and the industry itself could give back to the community. This year it is celebrating its 20th anniversary. The “440” refers to Florida Statutes Chapter 440 which covers workers’ compensation. The organization awards college scholarships to children of parents or guardians who were killed or injured in the course of their employment, and children of parents who are engaged primarily in the administration or operation of Florida’s Workers’ Compensation Law. Financial need is taken into account for all applicants. In 1991, the first year of the program, four students were awarded a total of $8,000. In 2010, 47 scholarships totaling $104,100 were awarded. This phenomenal growth is due in major part to Mr. Sadow’s passion, determination, and drive. His daughters Deborah and Patricia and granddaughters Kylah and Maddie play a prominent role in his life. After his daughter Jennifer was killed by a drunk driver, he began speaking about making responsible choices concerning drinking and driving. Mr. Sadow, a graduate of the University of Florida Law School, retired to St. Augustine in 2008 after an illustrious career in Miami. He currently volunteers at Mill Creek Elementary School mentoring and tutoring children. For further information go to www.440scholarship.org.
Donald T. Caruth, Esq., a West Virginia Senator, passed away on May 1, 2010, after a long battle with brain cancer. Don, 59, was elected to the West Virginia House of Delegates in 2002 and 2004, representing District #25. He was elected to the State Senate in 2004 and again in 2008. He served as the Senate Minority Leader for the 78th Legislature. Don worked across party lines to ably serve his constituents in Mercer County and the citizens of West Virginia. Senator Caruth was instrumental in leading the West Virginia Legislature to change the workers’ compensation statute and to develop a system to privatize the workers’ compensation insurance market. Privatization of the insurance market has resulted in lower premiums for employers, streamlined claims management to the benefit of injured workers, reduction of litigation, and more choices of insurance products from the voluntary market. Don was honored as the West Virginia Business and Industry Council 2008 Legislator of the Year. On March 13, 2010, Governor Joe Manchin presented Senator Caruth with the Distinguished West Virginian Award. Don received his B.A. Degree from Concord College in Athens, West Virginia, and earned his J.D. from the West Virginia University College of Law. Don was a partner with the Law Firm of Brewster, Morhous, Cameron, Caruth, Moore, Kersey & Stafford, PLLC, of Bluefield. As a practitioner, Don was a gentlemen lawyer always willing to mentor and provide advice to his colleagues. A highly respected political and civic leader, and a devoted husband and father, Don will be greatly missed.
Carrie Nevans was appointed Deputy Administrative Director and served the California Division of Workers’ Compensation (DWC) as its Acting Administrative Director since October of 2005. Ms. Nevans had a live kidney transplant in 2002 and passed away on February 6, 2011 due to complications from kidney failure. Ms. Nevans started her career as a claims adjuster for the State Compensation Insurance Fund in 1982. She was a certified self-insurance administrator, fully versed in all the specifics of workers’ compensation, as well as the ethics of claims administration. Prior to her work at the DWC, she gained administrative and fiscal expertise working for the Department of Corrections (CDC), the Department of Finance, the California State Senate and Department of Industrial Relations (DIR). While working in the DIR director’s office Ms. Nevans translated all three legislative reform bills (749, 228, 899) into comprehensive budget documents. As the DWC’s Administrative Director, she administered the division’s diverse programs and managed a staff of 1,200, along with a budget of over $135 million. During her five-plus year tenure as Deputy Administrative Director and Acting Administrative Director, the DWC effectively implemented workers’ compensation laws passed by the Legislature, which saved employers at least $70 billion cumulatively. Results of regulatory and other programmatic changes she carried out include a continued decrease in the number of claims filed and quicker resolution of claims, competition returned to the workers’ compensation marketplace, improved employer satisfaction with the workers’ compensation system, more injured workers returning to gainful employment and continued injured worker satisfaction with medical care, which is now evidence-based. Some specific highlights of her tenure include: (1) closing the repackaged drugs loophole, which saved employers millions of dollars; (2) increasing reimbursement for doctors evaluating and managing patients, which helped facilitate improved return to work; (3) developing a comprehensive research platform to empirically analyze the 2005 permanent disability rating schedule (PDRS) and other factors impacting wage loss; and (4) implementing a statewide injured worker outreach program, with special emphasis on Spanish-language outreach and high-risk worker communities. Ms. Nevans had a great sense of humor and a zest for life, and was very proud of DWC and the way it serves the people of California. She never stopped championing those impacted by the system and never gave up on returning to work personally, despite her medical challenges. Her presence as a leader with a brilliant mind for public policy and as a source of strength and inspiration cannot be overstated. She will be sorely missed.
Gregory A. Saxum, Esq., directed the workers’ compensation programs at Bethlehem Steel Corporation and then Eastman Kodak Company. A nationally recognized expert in workers’ compensation, particularly as it affected self-insured employers, Greg had served as president of the National Council of Self- Insurers and the New York State Self-Insurers Association. He gave selflessly of his time guiding both organizations and their members through the many changes seen in Workers’ Compensation Law over the decades. Greg continued to serve as Special Counsel for the state self-insurers association and, over the last ten years, for Hamberger & Weiss in the State of New York. Greg shared his invaluable wisdom and insight regarding all aspects of the workers’ compensation practice with so many constituents of the workers’ compensation community, until just weeks before his death due to bone marrow cancer this past July. A mentor and dear friend, Greg is sorely missed by many in the workers’ compensation community and will be fondly remembered for many years to come.
Hon. John M. Vittone, Retired Chief Judge, U.S. Department of Labor, Office of Administrative Law Judges, served as the Chief Judge from 1996 until his retirement in 2010. In 2010 he was appointed a Public Member of the recently reconstituted Administrative Conference of the United States (ACUS), and he chairs the ACUS’ Adjudication Committee. Judge Vittone serves as a member of the ABA Commission on Law and Aging and serves on the Council of the Senior Lawyer’s Division. Until 2009 he was a member of the ABA’s Commission on Racial and Ethnic Diversity in the Profession. Judge Vittone was elected to the position of Judicial Member-at-Large to the Board of Governors of the American Bar Association from 2000-2003. He is the past Chair of the ABA Justice Center and is a member of the ABA House of Delegates. Judge Vittone is a graduate of the University of Richmond and the Law School of the University of Kentucky. After law school, he served in the U.S. Army, reaching the rank of Captain. After his honorable discharge from the Army, he worked as an attorney at the Federal Trade Commission and the Antitrust Division of the Department of Justice. He then was appointed as a judge for the Civil Aeronautics Board and Department of Transportation. In 1987 he joined the Department of Labor, Office of Administrative Law Judges, as the Deputy Chief Judge. While serving as Chief Judge from 1996 to 2010, Judge Vittone was responsible for the management and overall operations of the Office of Administrative Law Judges, including the financial management of the Office, the assignment and timely disposition of all cases, the supervision of Administrative Law Judges and support staff, and serving as the liaison between OALJ and other agencies, both within and outside the Department of Labor. As Chief Judge, he also served as Chair of the Board of Alien Labor Certification Appeals, which considers and decides appeals filed by employers and aliens regarding denials of labor certification applications. In addition, he frequently met with attorneys and officials from other countries on the topic of our administrative judicial system, as well as traveling on an official basis to Chile and China. Judge Vittone was well respected by both sides of the bar for his depth of knowledge and impartiality. We honor him for his 24 years of dedicated service to the Department of Labor, Office of Administrative Law Judges.
Jennifer C. Jordan, Esq., General Counsel and a founding member of MEDVAL, LLC, is recognized as a leading authority on Medicare Secondary Payer compliance. She has provided practical advice and in-depth knowledge to virtually every type of entity subject to Medicare Secondary Payer (MSP) compliance. From Medicare Set-Asides to MMSEA reporting, she counsels clients while monitoring the legal landscape to identify and analyze emerging legal issues and trends affecting MSP impact and compliance. It is her belief that the only way to overcome this substantial and costly hurdle to insurance settlements imposed upon the industry by the federal government is to first reach a common understanding of what the MSP actually requires, and then utilize that knowledge to develop alternative compliance strategies; therefore, she has devoted considerable time over the years to educating attorneys and other professionals on MSP-related matters. In 2010 she gave presentations to a wide range of audiences, including for Lorman Education Services, HB Litigation Conferences, WorkCompCentral, trade associations such as the Physician Insurers Association of America and the American Insurance Association, and several bar associations throughout the nation and as far away as Hawaii. Also, in 2010, she decided it was time to take MSP education to the next level by serving as Editor-in-Chief of The Complete Guide to Medicare Secondary Payer Compliance (LexisNexis), a new comprehensive resource designed to help attorneys and others take control of their insurance settlements. In her role as Editor-in-Chief she took on the daunting tasks of mapping out the contents of the book, recruiting a group of talented individuals in the industry to serve as contributing writers, writing several chapters, the case summaries with commentary, and the glossary, and editing all other chapters and non-governmental resources for the book. To her credit, Ms. Jordan was able to bring competitors together to work on this book in furtherance of a common cause – i.e., to educate industry professionals on how to address MSP obligations in their settlements and thereby protect their clients and themselves from financial exposure.
The Claimant’s Attorneys:
S. Bradley Chalk, Esq., a solo practitioner in Santa Rosa, California, is the President-elect of the California Applicants’ Attorneys Association (CAAA) and a leading legal authority on impairment rating under the AMA Guides. A prolific lecturer to attorneys and physicians regarding the medical-legal aspects of impairment analysis, Mr. Chalk has influenced how these ratings are determined in California. He chairs the CAAA AMA Guides Committee, which meets every Wednesday for at least an hour, discussing and analyzing the AMA Guides. The use of the “four corners of the AMA Guides” in assessing impairment under the watershed Almaraz/Guzman cases in California is largely a product of his committee’s work. He presented materials at 7 conferences and testified in front of the California State Senate regarding the AMA Guides last year, and he also assisted in the preparation of the oral argument at the Court of Appeals for the seminal case of Guzman, by preparing the attorney with questions and answers. Mr. Chalk also created a method to rebut the AMA Guides 3% add-on for pain related conditions, and his article on that method, entitled How to Rate a Pain Impairment?, was recently published by the State Bar of California’s Workers’ Compensation Section E-News: January 2011. Mr. Chalk’s educational materials are widely distributed at seminars throughout the country. His talents have helped advanced CAAA technologically and organizationally, greatly enhancing membership communication and moving the organization into the 21st century. Mr. Chalk graduated from Gonzaga University School of Law, after obtaining degrees in Political Science and Philosophy at Sonoma State University. Mr. Chalk and his wife Robyn live in Santa Rosa, where he enjoys hunting and a five handicap in Golf.
Charles “Chuck” Davoli, Esq., Davoli, Krumholt & Price – of Counsel with Moore, Thompson, Lee & Broyles, Baton Rouge, Louisiana, is respected by his peers as an accomplished and experienced workers’ compensation attorney in Louisiana. In 2010 he continued his representation of injured workers and labor as an appointed member of the Governor’s Workers’ Compensation Advisory Council, and is a member of its five-person Executive Committee. As a member of the Council, Chuck chaired the Second Injury Fund Reform Task Force, assisted in updating the dispute Hearing Procedures for the State’s Office of Workers’ Compensation Hearings Division, and chaired the Council’s newly appointed Undocumented Worker Task Force. He is an active member of the workers’ compensation sections for both the Baton Rouge Bar Association and the Louisiana Association of Justice. He is a frequent lecturer on Louisiana workers’ comp law and practice, and in 2010 was invited to speak on various workers’ comp topics and issues on eight occasions, including presentations sponsored by LSU Law School, State Bar Association, Baton Rouge Bar Association, State Trial Lawyers Association, Louisiana Orthopaedic Association, and the State Department of Labor. In addition to his policy and speaking involvement, Chuck serves as Secretary and Information Coordinator for the newly formed Louisiana Workers’ Advocates Association (LWA), an affiliate chapter of the national Workers’ Injury Law & Advocacy Group (WILG). He also serves on WILG’s Executive Committee and as the Chair of WILG’s new “Workplace Safety and Occupational Disasters Committee”. Chuck also serves as a member of the Professional Advisory Board to IWP (Injured Workers Pharmacy), and serves as WILG’s liaison to IWP. He also provides a monthly publication service of jurisprudential summary reviews to workers’ comp practitioners in Louisiana, and provides a variety of Training and CLE opportunities in workers’ compensation law and practice. In addition to his trial practice, Chuck also has an active Mediation Service and in 2010 successfully mediated approximately 50 workers’ compensation cases. In 2010 he received WILG’s Presidents Award for his leadership contributions to WILG.
Robert G. Rassp, Esq., The Law Office of Robert G. Rassp, Sherman Oaks, California, has practiced workers’ compensation and Social Security disability since 1981. In 2010 he was honored by the California Division of Workers’ Compensation for its inaugural Community Service Recognition Award. Mr. Rassp also published a new edition of The Lawyer’s Guide to the AMA Guides and California Workers’ Compensation (LexisNexis), which was cited in 2010 by the Virginia Court of Appeal with respect to how Whole Person Impairment (WPI) ratings for hip replacements are calculated, served as Editor-in-Chief of Herlick, California Workers’ Compensation Law (LexisNexis), and participated as a contributing writer for The Complete Guide to Medicare Secondary Payer Compliance (LexisNexis). He spoke at numerous events in 2010, including the California Division of Workers’ Compensation Educational Conference, the California State Bar Workers’ Compensation Section Seminars, WorkCompCentral seminars, Source Seminars, and LRP’s National Workers’ Compensation & Disability Conference in Las Vegas, Nevada. In 2010, he served for the second year in a row as Chairman of the Board for Friends Research Institute, which promotes health and well-being through research, grants administration, education and treatment. As a tireless advocate for injured worker rights, he helped four injured workers in 2010 obtain 100 percent permanent total disability ratings “in accordance with the fact” under Calif. Labor Code Section 4662. The first client had been on a bilateral lung transplant list since the fall of 2009 due to her exposure to diacetyl (popcorn butter) and whose case potentially rated less than 100% under the WPI ratings from the AMA Guides. The second client had “routine” cervical spine surgery where something went wrong inter-operatively or post-operatively and she had a C-5 spinal cord motor impairment where she had lost complete use of her elbows and shoulders – she can only use her hands and fingers. The other two cases involved clients who developed chronic pain syndromes, one as a result of a pain drip that malfunctioned during routine elbow surgery and the other after failed carpal tunnel surgeries. Mr. Rassp also started a new law blog in late 2010 called The Rassp Report.
Kathleen G. Sumner, Esq., of The Law Offices of Kathleen G. Sumner, located in Greensboro, North Carolina, protects the rights of injured workers’ throughout North Carolina. Ms. Sumner is licensed to practice law in North Carolina, Hawaii, and the District of Columbia. Ms. Sumner has over twenty decisions from the North Carolina Courts which serve as precedent for workers’ compensation cases in North Carolina. Recently, Ms. Sumner obtained total death benefits on behalf of a minor child avoiding benefits being paid to the estranged spouse, not the mother. In another significant case, she represented an injured worker who sustained a compensable knee injury, resulting in the placement of two artificial knees. Defendants denied benefits to the injured worker for the staph infection and all subsequent sequale which resulted in amputation of the injured workers’ leg. Ms. Sumner was able to prevail before the Industrial Commission and obtain complete benefits for the injured worker for the infection and the subsequent amputation. Ms. Sumner is in private practice, but she also teaches Torts and Personal Injury Law at the Duke University Continuing Education Program. She is a founding member of the Workers Injury Law and Advocacy Group (WILG), a nationwide group of attorneys who zealously protect the rights of injured workers. She has served on the Board of Governors for ATLA, now AAJ, and served as Chair of the Womens’ Caucus. Kathleen Sumner has been practicing for over 20 years and serves as the Chair of the Amicus Committee for WILG. In 2010 she filed a brief with the United States Supreme Court on behalf of the Respondent injured worker advocating for a level playing field for injured workers injured by defective products placed into the stream of commerce by foreign defendants. Her brief stands for an important proposition that third party cases are all the more important to injured workers as a result of the decline in state workers compensation benefits nationwide over the past 20 years.
George Santini, Esq., Ross, Ross & Santini, LLC, in Cheyenne, Wyoming, focuses on personal injury, insurance defense, and workers’ compensation cases. He is actively involved in the Wyoming Trial Lawyers Association (WTLA), where he was a past president and also served on the Board of Directors. He is widely regarded as a leader in the Wyoming workers’ compensation bar and a committed advocate for injured workers. In 2008, WTLA began an effort to increase benefits for injured workers. George was instrumental in the year-long effort to raise public awareness about the problems with Wyoming’s workers’ comp system. He was key in helping to draft legislation considered by the Joint Labor Health and Social Services Legislative Committee and in helping to guide HB 54 through the legislative process. HB 54 was passed unanimously by both the Wyoming House and Senate – an amazing vote for workers in Wyoming. The Governor signed the bill into law March 5, 2009. HB 54 has definitely had an impact on injured workers in 2010. As a result of this legislation, the state must pay its pro rata share of attorney’s fees and costs in third party law suits where an injured worker recovers. The benefits for children of deceased workers were increased to $250 per month until the child reaches age 21 or 25 if pursuing higher education. For lower wage earners, a minimum rate for temporary total disability benefits was established. The legislation also improved death benefits for deceased workers’ families and extended surviving spouse benefits from 54 to 100 months. Permanent total disability awards are also now adjusted annually for inflation, and employees no longer experience financial hardship while waiting for permanent partial impairment or permanent partial disability benefits to begin. In 2010, George helped the WTLA defeat HB 71, which would have changed the appeal process for injured workers by essentially cutting off appeals to the Wyoming Supreme Court. George is also an excellent teacher and a frequent seminar speaker to help colleagues advocate for their clients. He spoke during WTLA’s October 2010 program on Damages, where he covered everything but the kitchen sink on workers’ comp issues. In addition, he helped WTLA organize another program with the Office of Administrative Hearings to help lawyers understand problems in the hearing process, particularly with the length of time a case takes to move through the process. Mr. Santini is also the current Chairperson of the Permanent Rules Advisory Committee, Civil Division, of the Wyoming State Bar, where he and others are responsible for maintaining and writing the Rules of Civil Procedure as used in the State District Court.
Mark Zientz, Esq., practices law as a claimant’s attorney at the Law Offices of Mark Zientz, P.A. in Miami Florida. He is Florida Bar Board Certified in Workers’ Compensation and serves on the boards of Florida Workers Advocates and the Workers Injury Law and Advocacy Group. In 2010 he successfully argued at the trial court and the appellate level on behalf of his injured client in Coastal Masonry v. Gutierrez, 30 So. 3d 545 (Fla. Dist. Ct. App. 3rd Dist. 2010). The appellate court affirmed the denial of the employer’s motion for summary judgment, ruling that the employer was equitably estopped from asserting the workers' compensation exclusivity defense in the injured client’s tort lawsuit after the employer had denied the injured client’s workers’ compensation claim on the basis that the injury had not arisen out of his employment. In another noteworthy ruling, Mark obtained a reversal of a trial court’s ruling that his client’s claim was barred by the statute of limitations. The appellate court ruled for Mark’s client in Gauthier v. Fla. Int'l Univ., 38 So. 3d 221 (Fla. Dist. Ct. App. 1st Dist. 2010), holding that the employer could not assert the statute of limitations because it had failed to obtain a date of maximum medical improvement and a permanent impairment rating from the physicians that it had chosen as the employee’s medical providers. Another significant appellate victory for a client was the reversal of a denial of cervical surgery for an injured worker who had previously been injured on the job for the same employer. The second accident occurred after the statute of limitations had run for the first accident, which also resulted in cervical surgery, and the claim had been denied after a finding that the need for that surgery was due to preexisting degenerative changes, some predating the first accident. In another appeal, he is challenging the constitutionality of the current law that requires the Judge of the Compensation Court to award only attorney fee scheduled amounts and prevents the JCC from approving agreements for more than the scheduled amount. Finally, he accepted a request that he serve as appellate co-counsel in an appeal of a denial of benefits to a catastrophically injured pair of workers who were injured in a car accident, where the claim was denied at trial because the workers' compensation policy issued to the employer was void ab-initio as a result of the fraud of the employer in securing the coverage three years earlier.
The Defense Attorneys:
Michael I. Fish, Esq., Fish Nelson LLC, Birmingham, Alabama, is a member of the American Bar Association, the Alabama Bar Association, the Birmingham Bar Association, the Alabama Self Insured Association, the Alabama Workers' Compensation Organization, the West Alabama Workers' Compensation Organization, the Defense Research Institute (State Delegate to the Workers' Compensation Committee), and the Alabama Workers' Compensation Defense Lawyers Association. Mr. Fish regularly speaks nationally at seminars and prepares materials on topics related to matters involving insurance defense with an emphasis on workers’ compensation. He was selected by his peers as Birmingham Business Journal's "Best of the Bar" for Workers' Compensation in 2005 and 2006 and “Top 40 Under 40” in 2009. In 2010, while he served as Chair of the American Bar Association Tort Trial and Insurance Practice Section Workers' Compensation and Employers’ Liability Committee, he co-chaired a three-day seminar jointly with the Labor and Employment Law Section Workers’ Compensation Committee covering cutting edge topics and featuring top notch speakers, planned a teleconference on the new mandatory reporting requirements of the Medicare, Medicaid & SCHIP Act of 2007, developed a new liaison program to spread the word about important national issues affecting workers’ compensation and to increase membership of the Committee, and worked with a Task Force to study the impact of applying the AMA Guides on the evaluation of permanent impairment in workers’ compensation claims throughout the country. In 2010, Fish received an AV Rating from Martindale-Hubbell. An AV Rating shows that a lawyer has reached the height of professional excellence. He or she has usually practiced law for many years, and is recognized for the highest levels of skill and integrity. Also in 2010, Fish and his law firm became a member of the National Workers’ Compensation Defense Network. The NWCDN is a nationwide and Canadian network of independent law firms created to provide an organization where reputable law firms of the highest reputation and expertise could form a comprehensive network to provide employers and insurers access to the highest quality representation in workers' compensation and related employer liability fields. Fish currently serves as the Chair of the NWCDN Marketing Committee. Fish developed and is a regular contributor to the Alabama Workers’ Comp Blawg which was named a LexisNexis Top 25 Blog in 2009.
Diana L. Wann, Esq. Ms. Wann has practiced workers’ compensation law since 1990. She left the Indianapolis firm of Ice Miller after a long tenure to join McCray Lavallo Frank & Klingler, an Evansville, Indiana law firm when she formed its northwest Indiana office in 2003. Currently her practice is focused solely on defending employers in workers’ compensation actions. Ms. Wann was honored in 2010 when named Indiana Super Lawyers and Corporate Super Lawyers in the field of workers’ compensation, as well as Best Lawyers in America for the third year. Ms. Wann is a founding, charter member of the National Workers’ Compensation Defense Network, for which she currently serves as Vice President, and was named a fellow of the College of Workers’ Compensation Lawyers in March 2010. She was instrumental in the initial recruitment, initiation and organizational efforts of the first class of the College in 2006. As the past management chair of the American Bar Association’s Labor and Employment Law Workers’ Compensation Committee, she helped lead the group from scant meeting participation in the mid-1990's to its current vibrant and well attended mid winter meeting agenda. In 2010 Ms. Wann was the Chairperson of the National Workers’ Compensation Defense Network 2010 Workers’ Compensation Symposium held in Chicago, spoke before the Indiana Continuing Legal Education Forum on the subject of How to Resolve Workers’ Compensation Claims with Medicare Beneficiaries, and presented at the Council on Education in Management Program on the subject of Bad Faith, Lack of Due Diligence and How to Avoid Such Claims. She continues her commitment to Kids Chance of Indiana by serving on the 2010 Board of Directions for the organization that she helped found in the State of Indiana in 1996.
Karen Caterino, the Risk Manager for the Nevada Department of Administration, Risk Management, began her employment with the State of Nevada in January 2009 and has made a remarkable impact in a short time. With state and local governments facing increased public scrutiny, Caterino has successfully demonstrated the ability for a risk management division to operate efficiently with over 80% of its functions outsourced or privatized. Caterino utilizes a network of insurance brokers, loss prevention and control consultants in addition to a third party administrator to help manage statewide risk exposures, with minimal staff to manage consultant contracts and services. Caterino restructured the worker’s compensation program, including the introduction of a non-affiliated, URAQ-accredited managed care organization. The MCO utilizes a select panel of credentialed, statewide providers that are mandated to follow evidence based medicine while adhering to ACOEM guidelines, particularly in the areas of cervical and spine. In return, panel providers are minimally discounted from the state fee schedule, thereby encouraging providers to spend time with the injured worker and communicate with the employer. This process ensures a qualitative approach to care and treatment of the injured worker while providing quantitative cost savings. Caterino has begun work on an innovative risk financing alternative for the state’s long term obligations with respect to public safety presumptive benefits, which include heart, lung and infectious diseases and certain cancers. The proposed alternative is a segregated cell captive for statewide public entities to collectively adopt best practices while managing the long term financing related to these benefits.
William Zachry is Vice President, Risk Management, for Safeway, Inc. While serving on California’s Fraud Commission, Zachry was involved in a study to review workers’ compensation payment accuracy. A major finding was that a significant number of medical payments were for treatment that not medically appropriate or for treatment that was outside of the Medical Provider Network, and that none of the treatment had been authorized. Based on that study, Zachry conducted a similar audit of his own claims operations and found that Safeway’s situation echoed the California study. Safeway claims operations, implemented a program where 100% of the requests for medical treatment were authorized by medical professionals, based on ACOEM treatment guidelines and evidence based medicine. They also connected the medical utilization review program to the bill review program (the first in California). The results were improved care for the injured workers, faster and more complete recovery by the injured workers, and a significant reduction in the payment for lost time days. Because of this program, Safeway realized a very significant reduction in medical costs. And has an anticipated long term reduction of its exposure to medical expenses. In order to reduce the severity of its workers compensation claims, Safeway has also implemented a pilot Medical Functional Retention Program for “at risk” injured workers (with Kaiser on the Job at its Walnut Creek clinic.) Highlights include an intake questionnaire, identification of “at risk” individuals, increased psycho-social counseling and physical therapy. And increased contact from the employee’s supervisor and assigned claims examiner. Of the sixty six claimants who had acute back injuries, the results over a three year period are; 100% returned to work, one had back surgery, and zero litigation. This program is now being expanded to other clinics in the MPN.
Greg Krohm, the Executive Director of the International Association of Industrial Accident Boards and Commissions (IAIABC) since 2000, will be stepping down from his work at the IAIABC at the end of 2010 and will be missed. For several years, Krohm has been one of the most insightful and influential leaders in the workers' compensation world. In 2010 he presented a paper entitled “Experience Rating Systems in the US” at a conference hosted by the International Social Security Agency in Baku, Azerbajan. He participated as an invited international observer at a conference of the Turkish Social Security Administration in, Ankara, Turkey, and participated in two programs of the International Social Security Agency in Dresden, Germany on International Benchmarking Survey and Estimating the Returns on Prevention Survey Project. He was the Keynote Speaker at the NCCI Regulatory Forum held in conjunction with the NCCI Annual Issues Symposium in Orlando, Florida, and served on the Planning Committee for the International Forum on Disability Management, which hosted the Forum in Los Angeles. Krohm presented “Nanotechnology and Workers’ Compensation Claims” at an AMCOMP Seminar on Challenges to WC Systems in New York City, and presented “Implications of Federal Health Reform for Workers’ Compensation,” at the AASCIF National Issues Forum. He delivered three papers at the IAIABC Annual Convention in Los Angeles, on “Emerging Disease Issues in Workers’ Compensation,” “Benchmarking International WC Systems,” and “Implications for WC from Affordable Health Care Act of 2010”. In addition, Krohm wrote papers, contributed to blogs, and conducted an IAIABC Webinar on the topics of Impacts of Recession on Workers’ Compensation Systems and How the Affordable Health Care Act Will Impact Workers’ Compensation Systems. He submitted written testimony to the House Subcommittee on Workforce Protections regarding Recent Trends in Workers’ Compensation Law. Krohm wrote a paper titled “Privatization of Workers’ Compensation Systems in the US” for the IAIABC Journal, and he wrote “History of Workers’ Compensation” for the NCCI Annual Report 2010.
Danielle Lisenbey, the Chief Operating Officer, Medical Management Division, Broadspire, a Crawford Company, has established herself as a leader in the industry by developing strategies for controlling the medical cost of workers’ compensation for employers and insurers. Throughout 2010, Lisenbey led the development and deployment of innovative services and solutions that complimented Broadspire’s breadth of claims and medical management services that provides customers with a Total Loss Cost approach. This approach focuses on helping the employer reduce their overall loss costs and administrative cost as well. By using their analytical expertise, Broadspire is able to model the cost drivers of loss and develop specific programs to address those costs with open transparency. Key strategies for 2010 included the creation of a multi-dimensional, multi-layered PPO network strategy, Broadspire's Original Landmark Design Network, which coordinates care with regional networks across the country to create better coverage and better savings than traditional networks. By using this by-jurisdiction approach, employers were able to see penetration rates with savings exceeding the national average. Coupled with the network strategy was the development of a DME (durable medical equipment) formulary program using technology and clinical protocols to revolutionize the DME process. By applying the cost management principles of a pharmacy formulary to DME, the medical needs of the injured worker are met while at the same time ensuring a measurable reduction in total costs for medical equipment and supplies. Another key strategy Lisenbey employed in 2010 was a comprehensive Chronic Pain Management program. With chronic pain costing employers over $60 billion annually, she spearheaded Broadspire’s interdisciplinary approach, which maximizes the injured worker’s quality of life and improves productivity while reducing medication dependence and controlling medical and lost-time costs. Lisenbey, her Chief Medical Officer, and team of clinical experts developed a Medical Cost Analysis (MCA) tool, which utilizes years of medical bill review and pharmacy data from Broadspire. The MCA takes the client’s medical data and trends the cost and utilization patterns of the client’s specific medical cost drivers. This allows the client and Broadspire to partnership and develop key action items to further reduce the client’s total loss costs.
Rebecca A. Shafer, JD, President, Amaxx Risk Solutions, Inc., looks beyond her peers in how companies can reduce workers' compensation costs. An industry leader for 25 years, Shafer has invented a patented (December, 2010) web-based application for workers’ compensation scoring, benchmarking and improvement. The online system contains a best practices scoring system that measures employers’ business practice proficiency in workers’ comp cost containment, much like a credit score. Employers obtain their National Workers Compensation Management Score®, which provides a numerical index of how well they are managing their workers’ compensation program based on 87 best practices. It is a predictive indicator of workers’ comp management success when analyzing all key cost drivers that can be used proactively by a company or by carriers to establish a threshold risk profile for premium calculations. Multiple divisions of a company get individual scores that are ranked from best-to-worst (or worst-to-best), thus providing the risk manager with an overall corporate needs assessment. Each division receives a Stoplight Report indicating which best practices are most critical. All divisions’ results are compiled into a Gap Analysis identifying, corporate-wide, which best practices have not yet been implemented and a Best Practice Profile showing current best practices for all divisions cumulatively. These allow training to target areas that are currently deficient. Rather than simply blaming their insurance companies and finger-pointing, companies can now look in the mirror to see what they should be doing internally to improve their practices (improving employee communication, telling employees they are a valued member of the team, offering transitional duty assignments, visiting their claims administrators, etc). This system also generates "recommendations" for each operating unit instantly so they can immediately begin improving their processes. In 2010, she also wrote a book on cost containment. She toured medical cost containment services across the country, learning about new techniques so the most up-to-date information can be available to employers, both in her book, “Manage Your Workers Compensation” and on her website and her blog, Workers' Comp Kit Blog.
Susan Toussaint, co-founder of The WorkComp Advisory Group, is an effective educator and coach to Independent Insurance Agents who wish to acquire better communication skills and knowledge about how employers can take control of their workers’ compensation costs. The open exchange of ideas that Toussaint creates allows Agents to question and evaluate current techniques and strategies in an effort to improve their skills, Her 15 years of healthcare and workers’ compensation experience, which includes the training of over 1,000 Agents, provides a wealth of useful knowledge that helps both Agents and employers to have improved efficiencies and greater outcomes. She is co-creator of The DAPPER Process™, which helps employers to discover the causes and cost drivers that are increasing, or contributing to, the costs of their workers’ compensation insurance. This process also guides employers to solutions of these issues in an understandable and meaningful way so they may regain control of their costs. In addition to the development of The DAPPER Process™, Toussaint co-created The VOICE Process™. The VOICE Process™ assists Agents with their process for getting in the door with leverage and aligning messaging with their workers’ compensation capabilities. In 2010 Toussaint developed a turn-key consulting program (The Employer’s STEP Advantage) for brokers that assists employers and risk managers in identifying and reducing the number, cost and duration of employee injuries. Additionally, she conducts WorkComp WorkShops for Agents to assist them in gaining the technical knowledge necessary to engage with employers in a consultative manner, allowing for greater success in reducing the costs associated with their workers’ compensation program. During the past year Toussaint developed a Supervisor Training Program for Insurance Brokers (Supervisors Matter) to implement at employer sites, hosted a 2 day Knowledge and Networking event in Chicago for brokers, vendors, insurance companies and educators in the Workers’ Compensation field to discuss strategies for improving workers’ compensation strategies, published several articles in insurance trade journals that focus on improving the sales process for insurance brokers, and conducted Webinars for insurance brokers on topics relevant to improving outcomes in Workers’ Compensation for employers.
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