Tipping Point: Cruise Ships Set Sail Close to the Edge

More than five times as high above the water line as it is below the water line, the Costa Concordia reveals how modern ship design push the boundaries of safety.



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Obama Rejects Pipeline from Canada to Texas (USA Today)

-- Related Coverage EU Demand for Road Map to Climate Treaty Complicates Talks (Bloomberg Businessweek) (11/28/11) Supreme Court to Decide Whether Lawsuits Require Harm (Yahoo! News) (11/28/11) Merck Pleads Guilty, Agrees to Pay $950 Million in Vioxx Case (Forbes) (11/28/11) GM to Offer Free Loaner Cars to Volt Owners During Safety Probe (Chicago Tribune) (11/28/11) Oklahoma Gets String of Mild Earthquakes (New York Times) (11/28/11) --

January 24, 2012

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Safety Probe Clears Chevy Volt (Wall St. Journal)

-- Related Coverage EU Demand for Road Map to Climate Treaty Complicates Talks (Bloomberg Businessweek) (11/28/11) Supreme Court to Decide Whether Lawsuits Require Harm (Yahoo! News) (11/28/11) Merck Pleads Guilty, Agrees to Pay $950 Million in Vioxx Case (Forbes) (11/28/11) GM to Offer Free Loaner Cars to Volt Owners During Safety Probe (Chicago Tribune) (11/28/11) Oklahoma Gets String of Mild Earthquakes (New York Times) (11/28/11) --

January 24, 2012

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BP May Double Oil Spill Pay-Out (Financial Times)

BP may agree to pay up to $25 billion to settle all charges, including possible criminal charges, with the U.S. government over the devastating Gulf of Mexico spill, according to an analyst at Morgan Stanley, double the figure the company has set aside.



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People on the Move: Specialists

Kane in at Dewey & LeBoeuf

ALICE KANE has joined Dewey & LeBoeuf LLP as a partner. She was most recently general counsel for the Americas at Zurich Financial Services, the insurance practice of the firm as a partner.

Related Coverage Target Markets Survey Shines Light on Programs Coverage (11/02/11) Lighter Headwinds Buffet Brokers in Third Quarter (11/03/11) Honoring Worker Safety and Injury Prevention (11/01/11) 12 Executives to Watch in 2012 (12/01/11) Consumed With Risk (12/01/11) John Pruitt, partner and co-chair of the firm's Insurance Regulatory Department said: "We're very excited about Alice's arrival at the firm. She is a leading figure in the insurance industry, and has a great track record with a number of major US and international insurance companies. Bringing Alice's extensive boardroom experience and insights from the general counsel's perspective into play in combination with our preeminent position in the insurance sector presents some really significant opportunities for the firm."

LWG Names Leader of New Cyber Analysis Practice

JEFFREY HARTMAN has been named leader of the newly formed cyber incident analysis practice at LWG Consulting Inc. The group brings together newly developed cyber security expertise with LWG's existing hardware/software failure analysis laboratories and computer forensic capabilities to provide advanced investigations and response to many different types of high-tech incidents such as network intrusions, virus/malware attacks and unauthorized disclosure of protected information. Mr. Hartman will also be charged with growing LWG's existing computer forensic practice.

Prior to his involvement with LWG, Mr. Hartman founded and managed a successful computer forensic firm, Impact Forensics, and served as director of the computer forensic division of RGL Forensics.

"While we have always been known for our expertise in incidents involving information technology, Jeff's leadership and the new talent we have acquired significantly advance our efforts to become the premier global provider of post-loss technical expertise," said LWG Consulting President and CEO Bob Wedoff. "We're excited about serving our client corporations, insurers and their respective legal counsel in new ways that help quarantine risk and reduce uncertainty."

VLAD UHMYLENKO has joined U.S. RE Analytics as managing director and principal. He had formerly served as director-enterprise risk management at Standard & Poor's. Prior to Standard & Poor's, Uhmylenko served for 12 years at Aon in various risk management consulting roles. His main area of analytical expertise is decision making under uncertainty, which includes economic capital modeling, dynamic financial analysis and program optimization.

"We're pleased indeed that Vlad is joining U.S. RE Analytics. He is recognized as a thought leader in Enterprise Risk Management. His specialized knowledge and experience working with S&P-rated companies will bring an important new dimension to the U.S. RE Analytics practice," said Tal Piccione, chairman and CEO of U.S. RE Companies, Inc., parent of U.S. RE Analytics.

September 13, 2011

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How Many Injured Workers Die from Opioids?

Just how risky are prescribed opioids for injured workers? And what are the main barriers to cutting this risk? One of the barriers, we shall see, is that conventional claims operations almost certainly have led to underestimating this tragedy.

The Centers for Disease Control and Prevention reports that more than 27,000 people died from all kinds of prescribed drug misadventures in 2007, a number that had risen five-fold since 1990.

Related Coverage Return-to-Work Challenges (12/01/11) Recalling the Crisis of 1991 (11/01/11) Assessing OSHA's Effectiveness (10/15/11) Learning from History (12/01/11) Back Injuries Become Epidemic (10/01/11) Deaths linked specifically to opioids have risen steadily in the U.S. from the late 1990s. In 2008, deaths associated with all prescribed painkillers approached 15,000.

To estimate the toll among injured workers, we are dependent on one research team, supported by the Washington State Department of Labor and Industries, which includes the state's monopolistic state fund.

The team's study of Washington worker death reports from 1996 through 2002 suggests, roughly, that about six injured workers per year definitely or probably died due to accidental overdoses of prescribed opioids. The immediate cause of death was respiratory failure.

The researchers found over this six-year period "a modest overall increase in opioid prescriptions; a dramatic shift from use of Schedule III/IV opioids to use of more potent Schedule II opioids; and among the long-acting opioid prescriptions, a 50 percent increase in average daily morphine equivalent dose." Patients who received higher opioid doses were nine times more likely to overdose than were those receiving low doses.

With the conservative figure of six deaths per year and the fact that Washington holds roughly 2 percent of the nation's population, one can estimate that, at that time, the annual national opioid-related deaths of injured workers nationwide exceeded 200.

That was at the start of the surge in opioid prescribing. Washington researchers tracked opioid related deaths since 2002 and reported this month a disturbing increase, about a doubling or more, of deaths "definitely" related to opioid use through 2009.

The CDC estimates that in 2008, Washington state had an above-average rate of prescribed drug overdoses. But even taking this into account, it is hard to see how total annual deaths in the last decade could be under, say, 200 per year or 2,000 for the entire decade. One could just as reasonably estimated 3,000 for the decade.

An estimate of between 2,000 and 3,000 deaths is buttressed by a close examination of opioid-related deaths by a prominent regional East Coast carrier.

Yet many medical doctors, claims and managed-care professionals show little awareness of anything like this pattern of deaths. Is this admittedly crude estimate of 2,000 deaths a mirage?

The truth, a disturbing one, is likely that standard operating procedures of claims adjusters steered claims departments toward seriously undercounting the number of such deaths. Claims experts said that claims adjusters are often coached not to inquire about the cause of death of a worker who had settled an indemnity claim and continued to use prescribed opioids. These are precisely the workers at greatest risk.

Claims adjusters can be expected to more diligently search out death certificates for workers who died while on disability, to affirmatively close a file. But even this cannot be assured. One retired medical director of a major insurer never had occasion, over decades of service, to review the quality of evidence obtained about deaths.

These opioid-related deaths are the lost, invisible cases. OSHA recording does not pick them up and insurers are not required to report them to state agencies. Had there been more accurate and timely reporting of these deaths, it is likely that the workers' comp system would have responded earlier and more forcefully to the risks inherent in opioid prescribing.

Happily, the tide has turned in Washington.

For publicly sponsored health programs including workers' comp, Washington set a "yellow flag" threshold of a daily dose of 120 milligram in morphine equivalent. The guidelines are available here. Gary Franklin, medical director of Labor and Industries, said that "since late 2009 and 2010, we have seen substantial declines in the highest doses and a decline in mortality in workers' comp for the first time in the U.S."

According to Franklin, the single greatest barrier to bending the curve on this problem is "failure to identify the risk as a public health emergency of the highest order."

Another doctor, employed by a managed care firm, attests to the opportunities and barriers to inducing better opioid prescribing.

Marianne Cloeren is medical director of a company that provides workers' comp case and disability management products and consulting services and has reviewed thousands of workers' comp files in the past few years, most of them complex cases involving work disability and chronic pain.

She said that "chronic opioid prescriptions, usually at high doses, are almost always a major complicating factor in these cases, and I cannot recall a single case in which published opioid management guidelines were being followed."

Cloeren initiated an early intervention approach that kicks in when opioids are prescribed for more than 30 days. "We request a copy of the injured employee's opioid management plan for their claims file. If indicated, resources such as the ACOEM opioid management guidelines and a proprietary activity prescription tool will be shared with treating providers."

Much of Cloeren's work is with injured federal employees. The major barrier to reducing opioid-related risks for these cases is a lack of accountability.

"The treating provider is not required to follow standards," she said. "The claims examiner is not required to review the treatment plan for appropriateness. The injured worker is not required to actively participate in recovery."

Opioid-related deaths of injured workers have been a particularly tragic kind of on-the-job death, as the deaths arise out of legal drug prescriptions. To be sure, many of these deaths involve the additional use of illicit drugs and alcohol. But, in the words of a member of the Washington research team, Michael Von Korff, "our results suggest that many overdoses may occur among people using prescribed opioids."

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Products: Jan. 24, 2012

TECHNOLOGY

ProspX, Inc. announced that HCC Specialty, a leading international specialty insurance underwriter, will join the ProspX platform and participate in ProspX InsiderConnect, an electronic marketing platform to automatically match critical news and information with specific new or renewal business opportunities in a broker's sales pipeline. The targeted insurance industry, line-of-business, and carrier specific information is delivered via a custom-generated e-newsletter.

Related Coverage Target Markets Survey Shines Light on Programs Coverage (11/02/11) Lighter Headwinds Buffet Brokers in Third Quarter (11/03/11) Honoring Worker Safety and Injury Prevention (11/01/11) 12 Executives to Watch in 2012 (12/01/11) Consumed With Risk (12/01/11) OCI, a data integration and software services provider, announced that its leave management system, LeaveXpert, is now offered in two versions: Compliance and Enterprise.OCI's LeaveXpert integrates various types of HR, claims and leave data into a single web-based application to improve legal compliance and yield a high return on investment in your HR department.

Both versions of OCI's LeaveXpert provide improved legal compliance and increased administrative productivity, but the new offerings now allow you to select an FMLA administration and tracking tool or a total absence management solution.

COVERAGES

Travelers today announced the availability of higher limits and broader Care, Custody and Control coverage for oil and gas well operators, non-operators and drilling contractors, who are being asked to assume more financial responsibility for loss or damage to non-owned equipment located at oil or gas lease sites.

Momentous Insurance Brokerage has announced the launch of their Equine Specialty Practice, which provides insurance solutions for private horse owners and horse-related businesses. As part of serving a luxury clientele, they have established deep roots in protecting luxury hobbies, which include owning, riding, and showing horses. Because the equestrian lifestyle can often blend private assets with business enterprise, these individuals need specialists with solid backgrounds in both personal and commercial insurance products.

INSURANCE

XL Group announced that the XL Group of companies has received final approval from the Brazilian insurance and reinsurance regulator, Superintendencia de Seguros Privados (SUSEP), to establish an insurance operation in the country. XL Seguros Brasil S.A. in Sao Paulo will offer a range of Casualty, Property, Professional and Specialty insurance products.

ARMtech Insurance Services, Inc. announced that ARMtech Mobile Applications has been expanded to offer crop insurance quoting and claims submissions. ARMtech' mobile capabilities allow insureds to view their policy information and agents to view their customer data from their smartphones and other mobile devices. The enhanced quoting and claims functionality expands on existing features which include the ability to track commodity prices, search for available insurance products, view actuarial changes, review policyholder and policy information and read agricultural-related news. The ARMtech Mobile Application is available for download through iTunes and the Android Market.

January 24, 2012

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