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Montana Self Insurers' Association

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  • Two WCRI Studies – Psychological Factors and Functional Outcomes Following Physical Therapy
  • Impact of CA Heat Standard on WC Outcomes
  • MSIA Part of a UWC Strategies Meeting with CMS
  • WorkCompCollege.com AI Podcast Performed by AI – 10/15 @ 11a MDT
  • Welcome New MSIA Members
  • Aggressive Medical Cost Containment
  • Override Health / Take Courage Coaching
  • WCRI Study – Psychological Factors and Functional Outcomes Following Physical Therapy

The Workers’ Compensation Research Institute (WCRI) released their study, “Psychological Factors and Functional Outcomes Following Physical Therapy” last month. WCRI reviewed claims from over 13,000 WC shoulder and knee claims, as a follow up to their prior study of the same kind of issues with low back pain claims. Workers’ compensation outcomes are compared to health insurance claim outcomes and are statistically worse for the same injuries.

Injured workers generally identified higher levels of negative coping, fear avoidance underlying fear of movement and negative mood when considering their workers’ compensation shoulder or knee claims. The functional improvements reported were 33-40% lower than those without those issues. 22% private health insurance patients with shoulder injuries reported high negative coping, while for WC injured workers, the number was 46%. Similarly 13% of health insurance patients reported fear avoidance, while WC patients came in at 32%. Those numbers lead to longer and more difficult recoveries. Perhaps this is not a surprise to many of us, but it may now be a sobering reference.

The study found that physical therapists (PTs) are beginning to take note of the psychological issues in workers’ compensation recoveries and some are implementing psychologically based approaches – graded exposure, motivational interviewing and cognitive behavioral techniques. PTs spend more time with injured workers than physicians do – typically – so maybe this is part of the answer to the issues of bio-psycho-social references in workers’ compensation claims.

WCRI Study – Impact of CA Heat Standard on WC Outcomes

WCRI released another new study last month, “Impact of California Heat Standard on Workers’ Compensation Outcomes.” The study identified that:

  • The CA heat standard resulted in a decline in the number of work-related injuries on hot days with substantial exposure to outside heat. WCRI found a 15 – 17 % reduction in construction, 24-27% reduction in agriculture and 19-25% reduction in transportation claims as result of the heat standards.
  • The decrease in frequency of work-related injuries on hot days for workers under 35 was 18% in construction and 27% in agriculture.

Many states (WCRI identified AZ, FL, GA, IL, MA, NJ, NY, RI, VA & TX) considered legislative heat standards of some kind this year and OSHA has indicated consideration of heat standards as part of a worker safety program. California was the first to enact heat related standards by law in 2005 and have since expanded them in 2010 and 2015; in 2024 CA enacted indoor heat standards. Since then, according to WCRI, CO, MD, MN, OR, NV and WA have enacted some kind of heat standard. 

CA also enacted significant overall system reforms in 2003, 2004 and 2008 (including changing the choice of physician from employee choice to employer choice). Earlier studies have identified significant claim count decreases based on those reforms. WCRI reviewed claims information from 2002 – 2005 as the pre-heat standard and then claims from 2006 – 2022 in four year intervals as the post heat standard period. WCRI used average temperatures based on zip codes and focused their reviews on the period of May – October as the most pertinent data sets. As another way of isolating heat standards as having an impact on claims, versus the reforms, WCRI compared CA information with AZ information, as AZ had not enacted a heat standard within their safety or workers’ compensation laws during this time period.

The CA standards required a number of steps to be taken for outdoor heat issues, including access to shade (which could include access to misters), access to water, emergency response procedures, acclimatization protocols and training for both workers and supervisors. More specifically, for Agriculture, Construction, Oil &Gas Exploration and Transportation for agricultural goods or supplies or construct equipment and materials, when the temp reached over 95, additional protections were required.       

Through one of our members, MSIA is a member of WCRI, and WCRI studies are available to you by contacting our office.

 

MSIA Part of a UWC Strategies Meeting with CMS

MSIA is an officer of the Board of Directors of the National Council of Self Insurers and is their designated representative on the Board of Directors of UWC Strategies (UWC). In that role, MSIA met with the COO of CMS and two of her deputies regarding MSA issues in workers’ compensation. Both the National Council and UWC membership represent business names you know – JM Smucker, Netflix, Chevron, etc.

UWC is a national business organization focused on unemployment and workers’ compensation issues at the federal level – perhaps most important for state WC systems, CMS rules, recommendations and guidelines on WC Medicare Set Asides (MSA’s). The UWC legislative efforts on MSAs have focused on the sticking points between CMS/Medicare concerns regarding protecting the Medicare Trust Fund and allocations of costs in a workers’ compensation claim that might hit Medicare eligible or soon to be eligible injured workers.

WC state statutory standards and CMS/Medicare standards are different, and can create issues within a settlement of a WC claim at the state level. For Medicare eligible, or soon to be eligible, injured workers, as payers we are required to take into account Medicare’s interest in not paying for medical treatments or drugs related to the workers’ compensation issues.

Here is the UWC list of issues where the two systems take different approaches, and was the basis for the meeting between UWC and the CMS COO:

  • CMS uses full life expectancy when estimating future medical expenses in an MSA. State WC systems may have an end date for benefits (MT is a good example) and accepts the idea that the injured workers’ life expectancy may be changed based on the injury and recovery;
  • WC systems may have limitations on how long medical treatment might last (as is the case with MT law), and the goal is recovery, not continued treatment for the remainder of the life expectancy;
  • WC more often than not, requires the use of generics when available (MT law) and works towards tapering programs when warranted and possible – particularly for opioids;
  • CMS does not accept the allocations of costs within a jurisdictional approved WC settlement;
  • CMS requires updates and maintenance of all MSA’s regardless of size – while for larger MSAs this is not much of an issue – for smaller settlements it becomes somewhat unrealistic.
  • There is no appeal process for CMS determinations of MSA levels.

UWC reported that CMS was interested in discussing all of the issues raised and appeared to support the option to pay the WCMSA amount directly to Medicare as a lump sum instead of claimants managing these funds (particularly for smaller settlement payments).

There was also an interest in reviewing prescription drug tapering and the impact of generics on future medical costs. More meetings through UWC are expected to be scheduled.

WorkCompCollege.com Podcast Performed by AI – 10/15 @ 11a MDT

In an industry first, Bob Wilson and Mark ‘RxProfessor’ Pew (and both friends of MSIA) will host a live Straight Outta Worker’s Comp Podcast, with AI powered interactive avatars as their scheduled guests.

Knowing these two, I’m not at all surprised that they have brought Alistair Ienstein, an “Academic Innovator” chatbot from WorkCompCollege.com’s virtual campus, to life for what they claim will be pithy discussion with Avatar Bob. Guests will be welcome to join the podcast, speak with the AI Avatars and ask them almost any question. They are inviting registered guests to play “Stump the (AI) Expert.”

MSIA has sponsored at least two Webinars on AI in our business and I plan on attending this Podcast (and have a question for the AI Expert). Registration and participation for the Podcast is free and available here: Live! Straight Outta Workers' Comp - Stump the AI Experts - WorkCompCollege - Workers' Compensation Certifications

 

Welcome New MSIA Member – Aggressive Medical Cost Containment

Please join us in welcoming Aggressive Medical Cost Containment (AMCC) as a member of the Montana Self Insurers Association (MSIA).

As an independently owned and operated firm, AMCC brings a specialized focus to the workers' compensation landscape, delivering top-tier medical bill review services with unwavering excellence in customer support. What sets AMCC apart is their deliberate choice to excel in one critical area - medical bill review - rather than spreading efforts across a broad array of cost containment solutions. This niche expertise positions them as a dependable partner for self-insured employers and administrators seeking precise, efficient results. 

With client relationships spanning decades, AMCC's success is rooted in core values of honesty, integrity, and transparency. Their team prioritizes a client-first approach, providing consistent, timely, and proactive communication tailored to each partner's unique needs.  AMCC crafts customized bill review strategies that maximize savings and satisfaction.

 

For more details on how AMCC can elevate your cost containment efforts, reach out to Eugene Barilla, Vice President, at 412-290-3158 or eugene@amccinc1.com or visit www.amccinc1.com to learn more.

 

Welcome New Member - Override Health / Take Courage Coaching

Please join us in welcoming back Override Health/Take Courage Coaching to MSIA. Nothing has really changed with Take Courage Coaching, Becky Curtis is still doing an amazing job and amazing things in helping people with chronic pain from injuries. She herself is the survivor of a horrific accident which has changed her life forever. It also brought about changes to so many others that she has helped.

Here are some Helpful Tips for Pain Coaches: Listen for strengths, not just struggles - A client who says, “I can’t do as much as I used to” is also telling you that they are still trying. By pointing out those moments of courage and persistence, you help clients see themselves as capable and strong. Normalize the Science of Pain - Pain is not always a direct measure of damage, but an output of the brain designed for protection – this can be life-changing. For a client who feels “broken,” this knowledge can open the door to self-compassion and possibility. Pace Progress, Celebrate Wins - celebrate every success, no matter how small: an extra hour of sleep, a short walk, or simply feeling less fearful of movement. Recognizing progress helps “rewire” the brain toward hope and resilience, reinforcing the idea that change is possible. Pain is not the end, it is only a part of healing and recovery.

 

For more information about Override Health / Take Courage Coaching and the incredible work they do, contact Becky Curtis at Becky@Override.Health or 406-381-2726.