The workers' compensation world is never short of experts. There are a multitude of moving parts in these state systems, and a great deal of interaction that leads from the premium paid to the benefits delivered. That has been a criticism levelled periodically, why are systems so complex? Well, in a nutshell, workers' compensation is complex because it is a microcosm of business, government, economics, and actuary.
Each of these is complex and challenging in its own right, and it is folly to think that somehow marrying two or more of these complexities together would somehow yield a simplicity. My seventh grade math teacher used to persistently mumble "two negatives make a positive," which one might argue means that through all the challenges, marrying two of these complexities together might create a simplicity, workers' compensation. It is not merely two, however. Three negatives, makes a negative instead of a positive. But, then again, I never really understood anything that math guy said; so, I became a lawyer.
Speaking of lawyers, there are those who see the world as involving too many lawyers (I am a lawyer). Others see far too many academics (I am an academic). I also hear criticism of actuaries, economists, and CEOs (I am none of those things). Our world, employment, relationships, are all imperfect. Markets, laws, the exchange of goods and services, are all imperfect. And, they are all complex. We can, at any moment in time, find many things about which to complain, at which to point fingers, about which to worry. And, likely validly so to some degree or another.
But, there are a great many complex analysis within workers' compensation that require the services and perspectives of lawyers, academics, actuaries, economists, and business leaders. We need to all remember, however, that the perspective of the workforce itself is more important. At the end of the day, workers' compensation is not a mental exercise, it is a critical support system for the people who go to work each day planning, making, and repairing the world in which the rest of us live. As one of the presenters at the WCRI mentioned Wednesday, the pandemic taught us that the "critical workers" were those who keep the world moving for us all. See You are Essential (March 2020).
Among those of us who do study this subject, there are those who labor each day in their respective furrow and struggle to find time or opportunity to look around and see those laboring beside them. For the non-agriculturally aware, a "furrow" is "a long narrow trench made in the ground by a plow." The analogy is that I work my part of the field, you work yours, and we largely perhaps do not notice each other (unless it is to crack a mean lawyer joke, actuary joke, etc.). Fortunately, there are a few opportunities each year to step out of our own furrow and strive to understand the bigger picture, the challenges of others, and the part we play each day back in that furrow.
This week, I am at the WCRI in Boston. What I really like about Boston is the food, but I digress. What I do not particularly care for is the cold. It is 39 degrees here this morning and I am missing the balmy (comparatively) 63 of Paradise. Sure, that is not the winter warm 75 degrees of Miami this morning, but of course Paradise does not have the crowds and traffic either. But, back to Boston, did I mention the food here is astounding? But, I digress yet again.
Thursday of this conference promises to be the best day. I admit and own my bias in that regard as I am participating on the closing panel on Thursday. We will discuss the 1972 National Commission Report. More on that in Friends, Romans, Countrymen (March 2022). See, I am biased toward my own panel, but I admit that bias. Like it or not, we are all biased in this world and we must strive to overcome those. I remind judges and regulators of this persistently. If you are an actuary, try to see Comp as more than a numbers game; if you are a lawyer, try to see it as more than a dispute system; in short, consider the role and value of others and their contribution to the whole of this (these) system(s).
On Wednesday, however, we heard from some exceptional voices in the workers' compensation community. They are, in part, old friends. We have heard many of them before, and despite the intervening Zoom efforts of the last 24 months, we are gratified to hear them again, in person, Live from Boston, it's workers' compensation! The food here is outstanding. Sorry, I digress yet again.
The program began Wednesday with one of my favorite academics, Robert Hartwig from the University of South Carolina. Dr. Hartwig is a favorite because he can take the heady and challenging of numbers and break it down for the rest of us. He reminds me of the scene in Margin Call (Myriad Pictures 2011). Jeremy Irons' character is the head of an investment firm, and in a very early morning meeting he asks a young associate to explain an issue with a complex investment security. He says
"please, speak as you might to a young child. Or a golden retriever. It wasn't brains that brought me here; I assure you that."
Many of us require that kind of simplicity when numbers and complexity are the topic. Dr. Hartwig presented on the global impact of COVID-19, in terms of economics, labor, management, and the foundational relationship of industry for which workers' compensation was designed and implemented. He did not speak to us like we were children, but he brought this heady combination of complexities down to a level everyone could comprehend.
Without work, there is no workers' compensation. This is, at its root, a system built on the concept of economics, markets, exchanges, and labor. We all likely too often forget those roots as we toil away in some furrow focused on some segment of the system mechanics.
Dr. Hartwig essentially told us that the economy has largely responded to the COVID-19 challenge. It is flooded with cash from multiple government infusions, and many consumers are seeking limited goods, thus prices have begun to increase. At the same time, supply chains have been interrupted locally and globally, leading to a short supply of some goods. Either decreased supply or increased demand may lead to price increases, and we are seeing both. And, the energy markets have been impacted by the Russian war in Ukraine as have general perceptions of economic stability. In short, we are in a recovery, but interest rates must rise to combat the inflation issues. Workers must be found to replace the retiring and the disaffected. Recovery is underway but is not complete.
If you ever get the chance, attend one of Dr. Hartwig's lectures. He really does make it comprehensible for us golden retrievers in the audience. And yet, he also appeals to the exceptionally intelligent whose post-presentation questions are so intellectual and challenging.
Two Wednesday speakers addressed the growing trend of provider consolidation in the U.S. Through various mergers or purchases, hospitals have joined together in chains. Physician offices have trended from independence to being hospital subsidiaries. There are marketplace perceptions of the practice of medicine morphing into the business of medicine: managed, calculated, ponderous, and perhaps less responsive.
Yes, there is economics and management in medicine also. Dr. Savych and Dr. Negrusa provided an interesting overview of what these trends portend for workers' compensation. Medical care is, after all, the largest and still fastest-growing portion of the workers' compensation expenditures. With medical inflation having been so expansive for the last 50 years, this portends an ongoing challenge for this industry; though Dr. Hartwig explains that medical inflation is not a major part of the present overall inflation threat. But see Langham, The Conundrum of Medical Inflation (April 2018),
The impact of chiropractic care was addressed, with emphasis on the low back complaints that are common in workers' compensation. This was a preliminary introduction of a 28-state study of the impact of this care in terms of frequency, costs, claim duration, and more. If you are not familiar with WCRI, this study somewhat epitomizes its ability and proclivity for drilling down into factorial elements and discerning performance, trends, and more. Wednesday's were preliminary results, and I look forward to perhaps writing about the study soon. As an aside, the market has been seemingly less wary of chiropractic care in recent years, with many finding the potential costs and challenges of persistent care and adjustment more palatable than the addictive and deteriorative path of narcotics that this market traversed over the last 30 years. I have been sometimes critical of Opioids, see Florida's 2018 Session - Opioids (March 2018) and the list of articles linked there. There has been so much addiction, death, and overdose from those substances.
The afternoon returned us to the COVID-19 topic, In retrospect and reflection, but also in prediction. The panel included: the risk and medical director of Albertsons, Denise Algire; the executive director of a construction organization - CISCO, Dan Allen; the regional medical director of Liberty Mutual, Craig Ross; and, Sebastian Negrusa of WCRI moderating. I always enjoy hearing Ms. Algire's perspective, she is insightful and direct. Mr. Allen was as direct and focused. The medical perspectives from the overview perch of Dr. Allen brought a certain clarity of perspective that was compelling.
They strove to address the impact of workplace mandates in the midst of the last 24 months, the changes and challenges of workplace injuries, the delivery of medical care, and the emotional considerations as workers return to normalcy following virtuality, lockdown, and isolation. The persistent challenges of vaccine mandates in the workplace also received some attention, and that particularly seemed future-focused - "how can employees be better supported emotionally."
There was significant discussion of the "long COVID." I have been discussing this for some time. See COVID-19 in Comp October Update (October 2020). The medical implications of this virus are still unknown. There was discussion of various medical studies that are foreshadowing the potential for many long-term implications and complications of this virus that will stretch on for years perhaps. Comments came even from the audience regarding the health effects of this; there is some consensus that this is not over in terms of overall impact.
The suggestion seems to support that illness and impact will persist and thus there will be costs for workers' compensation to bear. The afternoon panel reiterated some of those concerns, though perhaps less directly. But, the most compelling element of the afternoon discussion was the flexibility that may be required with return-to-work for those who even have an option. In that vein, there was a reminder of the fact that grocery store/supply chain workers cannot telecommute any more than construction workers or truck drivers. See You are Essential (March 2020).
There was a seeming consensus that return-to-work, for those who "went virtual" in the midst of the pandemic, will be challenging. This is challenging for those of us who never went virtual. Among office workers, I often get the feeling that perhaps only a very few of us remained at the office throughout. As an aside, the Florida OJCC never closed, never faltered and never failed. I am immensely proud of that team and the various judges that lead its districts and divisions. We really never missed a beat, though we were never perfect. See, When We Return (May 2020). I am privileged to work with such a motivated, dedicated, and outstanding group of professionals.
But, the panel voiced the conclusion that some will never return to the office environment and that a fair few more will be desirous of an ongoing hybrid environment. If for no other reason than the price of gasoline, but I digress. The hybrid issues are not new to these pages. See Evolving Work Challenges (January 2022). There is also a discussion of the emotional state of the American worker. This panel stressed that issues such as the "Great Resignation" (October 2021) are impacting the workplace, placing stress on the employees that remain, and these implications need to be factored into the challenges of work, management, and employee care (care for them or fail to retain them and their skills).
There is much curiosity of the challenges that telecommuting and virtual work create, foster, and perhaps enable. There are questions raised about the "going and coming rule" in workers' compensation when the office is one room down the hall instead of across town. The panel discussed the potential for more repetitive trauma injuries and ergonomic claims. One panelist mentioned efforts to easily afford the telecommuting worker with devices and equipment to facilitate the worker's effectiveness, health, and injury prevention. How many employers are thinking forward in this vein about preventing injury and accommodating the challenges of home-work? How many employees are struggling along on their kitchen table top?
In all, Wednesday was an informative and invigorating discussion. However, in fairness, Thursday is the real point of the whole show. The final panel, in case you missed it above, will be our discussion of the 1972 National Commission Report. In my heart, I am certain that is what the crowds are really here for, and I sympathize with their impatience and anticipation (sarcasm, our panel will be interesting to be sure, but it is merely the dolce, following a great workers' compensation feast). We will end the show with a flourish or with a whimper, hopefully reminding the crowd again of the real point of all we do: employers and their employees.
In just 12 months, the WCRI will likely be right back here for yet another (its 39th) annual conference. The audience is always engaged and engaging, the information always enriching, and the experience always rewarding. And, if you get the chance, the food in Boston is outstanding. Just sayin'.
