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MONTANA SELF INSURERS' ASSOCIATION

october 2021 Update

  • MSIA Annual Meeting – “Workers Comp Unmasked In The Post-Covid Era”    
  • AMA Guides Update   
  • Governor’s Conference
  • 5 Year Petition Data
  • Welcome New MSIA Members myMatrixx and Turner Vocational Rehabilitation
  • MSIA Business & Annual Meeting

Thank you to all who were able to attend or provided their proxies for the 2021 MSIA Business & Annual Meeting, sponsored by Browning, Kaleczyc, Berry & Hoven and Definiti Comp Solutions/Definiti Rx. Members adopted the Minutes from last year’s meeting, the proposed budget for the remainder of the year and proposed bylaw changes to help make the Association run better. Members will be getting a copy of the new budget, the DRAFT Meeting Minutes and the new amended bylaws under separate cover.

We also heard from Bob Wilson, President and CEO of workerscompensation.com. Wilson provided his perspectives on the past year in his presentation, “Workers’ Comp Unmasked In The Post-Covid Era.” Wilson offered all of us a pat on the back as part of the workers’ compensation system for responding to COVID with lightning speed. One day, it was business as usual with the required paperwork and wet signatures, and the next we had electronic documentation, electronic signatures and telemedicine.

Wilson also went through what we learned in the past year about our work, our relationships with others and how that affects our work. He also warned us to be careful about the laws we pass, as evidenced by HB 702, and in providing such broad presumptions within the laws. First, they are antithetical to the grand bargain of workers’ compensation and second they create two tiers of injured workers – those with the presumption and those who have to prove the injury or illness was based in work. He used the Parkland School shooting as an example, where teachers and counselors who were in the school do not have the presumption of PTSD coverage, but the responding Officer, who did not go into the school while the shooting was occurring, did. 

One of Wilson’s key points is that employers now seem to have far greater responsibilities in dealing with communicable diseases, including and beyond COVID, over which they have little control. The workplace responsibilities of employers have changed and how individual employers respond to them has been interesting. He noted specifically the issues we in Montana have with the enactment of HB

702, seemingly leaving us with the option of violating federal mandates or state law.

AMA Guides Update   

Montana workers’ compensation law (MCA 39-71-711) requires the use of the 6th Edition of the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides) for the impairment ratings used within our system. In August, the AMA announced updates to the 6th Edition of the AMA Guides (AMA Guides Sixth 2021) effective July 1 to address mostly mental and behavioral conditions. This is the first update to the AMA Guides since their initial release in 2008. 

ERD hosted a briefing session with AMA representatives on September 22 to review the changes and the longer range plans they have for continued updates. The AMA representatives stressed the inclusive nature of their current, and anticipated future updates to the Guides. They pointed out they sought out workers’ compensation system stakeholders to discuss the changes and anticipate broadening that group for future updates. The AMA anticipates an annual update to the Guides and will be providing them electronically instead of hard-copy. Montana law requires use of the 2008 version of the Guides and adoption of the AMA Guides Sixth 2021, and any subsequent updates will require legislative action, based on the current statutory language.

At this point, the changes reference the more current Diagnostic and Statistics Manual of Mental Disorders (DSM-V versus the DSM-IV which was in effect in 2008), eliminates the use of the Global Assessment of Functioning rating scale and provides more definition for “malingering” and greater discussion around patient motivation. MSIA will be talking to other Montana WC system stakeholders about the changes and the expected regular updates going forward and how we may want to see the current law changed.

Governor’s Conference

While a smaller Conference than usual, I cannot tell you how good it was to see and connect with people again. The ERD and DOLI staff did a wonderful job of putting together and hosting a conference in what may be best described as “interesting” times. All the presentations from the 2021 Conference can be found at the Conference website, 2021 Governor's Conference (mt.gov).

Todd Harwell and Dr. Maggie Cook-Shimanek provided a perspective of the 2018 Spanish Flu epidemic and a contrast to COVID. We have come a long way in our knowledge of science and ability to respond to different infectious diseases. For example, scientists were able to sequence the COVID genomes within a year of the disease hitting. As a result, we were able to develop COVID vaccines within the same year. In contrast, the Flu was not sequenced until the 1930’s and a vaccine was not created until the 1940’s. As well, every disease mutates – the current common cold, for as much as we know could be a variant of the 2018 Spanish Flu infection. Dr. Cook-Shimanek did not get political in her comments about COVID and provided some facts. The spread of Spanish Flu in 1918 was based on an average of each person who contracted it, spreading it to two additional individuals. The first variety of COVID is estimated to have be spread to three individuals by those who contracted it. In contrast, the Delta variant is estimated to be spread to seven individuals. Dr. Cook-Shimanek pointed out that 86% of the people in Montana hospitals with COVID are unvaccinated. Of those in the hospitals, the average age of unvaccinated people is 61, while the average age of those hospitalized is 74. Finally, those who are unvaccinated are four times as likely to get sick from the disease and five times more likely to die than those who are vaccinated. During the Q & A Dr. Cook-Shimanek was asked about the safety of the vaccines and she responded that with 1.6 billion doses provided around the world, she is convinced the vaccines are safe.

Kevin Braun provided an overview of the legislative activity during the year. Among the more important changes last year, was the provision of physician dispensing, excluding workers’ compensation patients. This idea was pushed by those supporting the Direct Primary Care model of health care and may have an impact on health insurance coverage, but with the amendment supported by both MSIA and MSF to exclude workers’ compensation, our system should not see much change in this regard.

Dr. Greg Vanichkachorn, formerly an Occupational physician in the Flathead and now with the Mayo Clinic provided a presentation on what he has seen at the Mayo Clinic regarding COVID and Long COVID. Dr. Van was careful to point out that his information is only that at this time – it is not a study, nor does the Mayo Clinic have enough data to provide statistical insight into the meaning of the information. However, his information supports a study done by Oxford University (as reported in April 19 MSIA Legislative Week 15 Update).

While based on their own clinical information the results lined up surprisingly well with the Oxford University study results. Some 10% of clinical COVID patients wound up with longer term issues – identified as issues presenting 90 days after initial COVID presentation (same as the Oxford study). 68% of the long COVID Mayo patients were women (72% in the Oxford study). There was no known predictor of the potential of long COVID. The most common symptoms are fatigue, respiratory issues, neurologic issues, including headaches and dizziness, “brain fog” (cognitive issues) and a host of other symptoms (as was the case in the Oxford study). Dr. Van pointed out fatigue in this instance is beyond normal and is represented by the need to rest for a few hours after simpler tasks. 75% of the Mayo Clinic Long COVID patients were not hospitalized initially with COVID, 22% had pre-existing respiratory or cardiac issues, and 34% had pre-existing anxiety or depression issues. The average age of the Mayo Clinic Long COVID patient was 45.

Dr. Van pointed out just as there was no predictor of Long COVID, there is no standard of care. He told us the most important treatment was monitoring and providing psychosocial support. As these patients are outliers and no one yet knows what causes the situation, helping them understand there is a real condition they are dealing with is most important. Empathetic treatment, while not medicalizing nor catastrophizing the situation was most effective. Dr. Van stressed that the unexplainable does not equal the non-existent. During the Q & A Dr Van was asked if the presence of the vaccine had any impact and he reported there was no measurable impact of the vaccine on long COVID issues.

Judge David Sandler provided his annual review of case decisions in the Workers Compensation Court and from the Supreme Court on appeals from his court. The important decisions have been reported in prior issues of the MSIA Update (available on the MSIA website, Montana Self Insurers' Association (mtselfinsurers.org). The number of petitions for hearings have increased noticeably in the last few years – from under 300 in 2018 to almost 500 in 2021. At the same time, the number of trials has gone down. Judge Sandler pointed out it is much more difficult and time consuming to run a trial via Zoom than in person and that played a significant part in the reduction.

Jennifer Wolf, Executive Director of the IAIABC – the association of workers compensation regulators – provided her perspectives on how our world has changed as a result of COVID. In agreeing with Bob Wilson’s comments she pointed out state regulators demonstrated a surprising level of nimbleness and quickness in responding to COVID. Almost overnight, the process by which workers’ compensation was done changed in providing telemedicine, electronic documentation and eliminating the need for wet signatures. As well, state regulators were able to pull together, and display, data from different aspects of COVID claims and treatments to provide meaningful and useful information on how it claims were being processed and what the data meant in different state systems. She pointed out even Montana, a small state system, had a sophisticated data visualization program, providing good information to all (COVID Related Workers' Compensation Claims (mt.gov).

Wolf discussed how over the more than 100 year history of workers’ compensation in this country, only three external forces have had an impact on our systems.

  • WW II when disabled veterans were returning to the workforce. Both labor and management were concerned about hiring and the costs of additional impairments to disabled veterans. The result was second injury, or subsequent injury funds enacted in all of the states. These funds typically pay for the difference between the impairment caused by the industrial accident, and the ultimate disability as a result of the combination of the pre-existing (non-work related) impairment.
  • The OSHA Act of 1970, which in addition to creating OSHA, created the National Commission on Workers’ Compensation. Their 19 Essential Recommendations, largely enacted by all the states, are the basis for the current workers’ compensation systems. In addition, their enactment prevented a federal take-over of the states’ systems.
  • COVID – literally overnight, some 65 million workers, more than 40% of the workforce, started working from home. As discussed earlier, state regulators responded very quickly and meaningfully as well in not only dealing with the regulatory changes necessary to support remote working and oversight, but to create the data dashboards. So far, we have seen over 1 billion telehealth visits – while there have been significant decreases in those visits, telemedicine law changes guarantee it is here to stay. With some 21 states enacting some kind of presumptions of coverage for either first responders, health care workers and essential workers, the ground rules in many states have changed. Wolf concluded that this past year saw more acceptance that mental health is health and it needs to be addressed in the workers’ compensation systems one way or another. We do not know yet what the impact of long COVID will have on our systems. As well, NCCI estimates that 1% of COVID cases generate 60% of COVID claim costs. 

MSIA member Connie Hoffman of Intermountain Claims was honored as the 2021 Workers Compensation Professional of the year. Connie was nominated by fellow MSIA member Leah Tietz of the Montana University System for her dedication and competency benefitting injured workers and their families. Hoffman brings the requisite expertise along with a persistent worker-recovery mindset to dealing with each injured employee and their families. Prior Workers’ Compensation Professionals of the year include MSIA members Marv Jordan of MCCF, Bob Worthington of MMIA and MSIA and Mike Marsh of Midland Claims Service.

Emily Healy and Bri Lake discussed the data and systems they are working with to create new ways to look at Montana workers’ compensation system information. In so doing, they created the data dashboard identified above, and are providing unique and meaningful information regarding our system, results and impacts.

Dr. Clarie Muselman, PhD with the third party administrator NARS Workers’ Compensation Center of Excellence followed up on her last live presentation to the MT Governor’s Conference regarding changing the mind-set of workers’ compensation claims work. Part of Muselman’s message was that words matter. Muselman challenged the audience to think about the implications of even just position titles we use – “Workers’ Compensation Adjuster” to the “Workers’ Recovery Unit” to a “Workers Empowerment Specialist” (in the Workers’ Compensation Center of Excellence). Muselman pointed out that while jobs may be 9 – 5, injuries are 24 hours a day, every day. And everyone has issues (she asked if anyone had in-laws, as an example). Recognizing these items and responding to them, rather than just reacting to the law makes a significant difference in injured workers lives, our results and in our staff.

Muselman pointed out that no one wakes up and decides to be an insurance person. Everyone in the room fell into this work. We all have recruitment, training and retention problems as well. By changing our mindset, in her experience, hiring social workers, for example, or working with people who have skills not available through college degrees, we can find the right kind of people who demonstrate the empathy to make a difference in an injured workers’ life - - and positively impact our bottom line. Her message was that everyone needs to be Seen, Heard, Acknowledged and Valued – whether they are injured workers or our staff.

The next Governor’s Conference will be in Missoula. MSIA will again bring in a nationally recognized speaker, will be a formal part of the Conference agenda and open our Annual Meeting to all attendees. The MSIA Business meeting is for members only and it is important for the running of our Association. Your input, regardless of the level of membership status as an employer or an Associate, drives our positions and efforts. Let me also add a personal thanks to those who attended the Governor’s Conference in person this year and who I got the first chance to meet. It has been an honor to represent you this past year and I look forward to next year.

5-Year Petition Data

The Employment Relations Division of the Department of Labor and Industry recently released the attached slides regarding the 5 year petitions to re-open benefits. I think the first surprise is that in the five years we have had petitions, there have been less than 500 petitions filed. I know I expected more. Of the 495 petitions filed, 236 have been resolved, one way or another. Our system has benefited from this change in law in providing continued benefits where necessary and terminating benefits where appropriate. One of the cost drivers in our system was, as a friend once told me, it was very easy to get in, and we never let you out. That has changed over the past 10 years and this data demonstrates that.

Welcome New MSIA Members myMatrixx and Turner Vocational Resources

myMatrixx is a unique PBM with an exclusive focus on workers’ compensation cases. They combine high touch customer service with clinical expertise and state-of-the-art business intelligence systems to deliver simplified solutions and positive outcomes. As an Express Scripts Company, myMatrixx leverages the robust pharmacy network of an industry leader, while still providing a smooth and personalized experience for clients and injured workers.

myMatrixx is committed to simple, predictable and affordable pharmacy benefits management: they put together the pieces of clinical support, high-touch service and actionable data to help you achieve your claims management goals.

Turner Vocational Resources, based in Big Timber, MT is a highly experienced disability management company providing a variety of timely and results oriented Vocational and Medical Management services to injured individuals within the Workers' Compensation, Auto, Life, Personal Injury and Disability markets.

Turner Vocational Resources is client focused and believe that facilitating maximum medical recovery and vocational potential of an injured or disabled person is in the best interest of all. They work closely with injured individuals and their families, claims adjusters, medical providers, employers and attorneys to support the best possible outcome in terms of maximum medical recovery, minimal residual impairment, earliest possible return to work and cost savings. Contact Rich Turner at Rich@TurnerVR.com 406.930.1970.