Shh, it's time for another round of “let’s discuss depression or suicide in the workplace." That’s right, shh. After all, we aren't supposed to discuss these issues. If we do, someone else may try to commit suicide. If we hush up the problem, maybe it will go away. So, help me to understand why we tolerate this silence with mental illness and not with any other medical condition. I think it is because mental health is a bit more mysterious and scarier than most other conditions. But mental health does account for a large percentage of the costs related to lost productivity ($51 billion). It generates direct costs of treatment of $26 billion a year[1] -- and “absence, disability and lost productivity related to mental illness cost employers more than four times the cost of employee medical treatment.”[2] We need to get over our fear and get the discussions out in the open. Only then will we have a chance to break the cycle. The goal of breaking the silence is already occurring on the high school level and is showing results. I realize that this is a different population, teen-agers, but talking about it really does matter in prevention. This most recently occurred in a high school in Crystal Lake, Ill., after two teen-age friends took their lives. The school and community leaders made a point of getting information to other students about the warning signs so that they could possibly identify those in danger and encouraged parents to talk with their teens about their grief. Leaders also provided grief counselors onsite and gave the students different options for grieving, which included holding vigils, providing groups and allowing for other forums of expression. This is an excellent model that can be adapted for the workplace in partnership with your employee assistance program (EAP). Here are some things employers can do for their workplaces after a suicide:

• Openly discuss suicide and offer grief groups to anyone directly or indirectly involved with the people who took their lives. Make it okay to talk about the suicide. For more information on steps employers might take, go to “A Manager’s Guide to Suicide Postvention in the Workplace.”
• Provide information about the warning signs so that employees can help identify others who might be at risk. Make sure that employees and their family members get information about resources that they can access for themselves, their family members or other co-workers. And stress the confidential nature of these sources. A great first step is the National Suicide Prevention Lifeline (800-273-TALK (8255)).

The best defense, however, is a good offense. To encourage prevention, I suggest the following:

• Create a “mental health/wellness” friendly workplace that involves openly discussing mental health and stress and making sure that employees know that there is confidential help available.
• Provide employees and managers with training on signs of depression, anxiety, etc. and encourage them to seek help if they or a colleague is showing any of these signs.
• Have your EAP visible through consistent promotional efforts using print, email and social media.
• Make sure that the company’s benefits plans have good mental health coverage.

I have been lucky enough to have spent the last 36 years in the field helping individuals and organizations become more open to dealing with psychological issues that may interfere with their professional or personal growth. And I have been amazed at how successful treatment can be when the issue is confronted head-on. As leaders in the insurance industry, those of you who subscribe to this blog are trusted advisers to the leadership and decision makers in organizations of all kinds. I therefore implore you to use these relationships to encourage them to face mental health in an open and forthright manner. Only when people are able to openly seek out help for mental health related concerns in the same manner that they seek out medical treatment for other issues will we be successful. [1] Managed Care Magazine (2006, Spring) Depression in the Workplace Cost Employers Billions Each Year: Employers Take Lead in Fighting Depression. [2] Partnership for Workplace Mental Health, A Mentally Healthy Workforce—It’s Good for Business, (2006), www.workplacementalhealth.org.

International regulatory bodies like the G20 and the Organization for Economic Cooperation and Development (OECD) are still pining for recommendations for regulators on how to avoid another financial crisis like the one that engulfed the global economy in 2008. The groups are increasingly leaning toward stronger consumer regulations to prevent another catastrophe, just like sophisticated regulators in the U.S. and other countries across the globe. The OECD, unfortunately, is taking a shortsighted approach to its consumer protection recommendations by suggesting one-size-fits-all regulatory standards will work for every regulator across the globe. The OECD’s consumer protection recommendations won’t be issued, or received, lightly. And suggesting misguided regulations is dangerous. The guidelines will be (rightly) considered by regulators in nearly every country, despite their very different levels of sophistication concerning financial markets and consumer awareness. We’ve seen movement on one-size-fits-all policies in this area for years, most recently with Solvency II and capital standard policies under consideration in Brussels. The latest version we struggle with is a recommendation for regulators on how to consider the OECD’s High-level Principles on Financial Consumer Protection. The principles are focused on the following areas:

• Legal, regulatory and supervisory framework
• Role of oversight bodies
• Equitable and fair treatment of consumers
• Protection of consumer assets against fraud and misuse
• Protection of consumer data and privacy
• Competition.

And the OECD recently issued draft guidance (framed as a “toolkit”) to address how best to approach the recommendations. Of course, each principle offers broad recommendations on how to manage issues affecting intermediaries. These could ultimately hit broker remuneration, transparency requirements, cooperation among supervisors and the like. And if the draft recommendations gain momentum, our ability to educate our regulators and shape sound consumer protection policies could be diminished. That’s why the World Federation of Insurance Intermediaries (WFII) has been following the proposed “toolkit” closely. The federation issued a strong response to the OECD’s suggestions, rightly calling out the organization’s shortsighted approach and its assumption that regulators should approach with the same vigor businesses large and small and products designed for individuals, multinational corporations and companies located anywhere in the world. The comments filed with the OECD by WFII rightly stated: “the pure fact that an effective approach has been developed in a range of jurisdictions is, in our view, not an indication in itself that it is indeed an ‘effective’ approach. We believe that sound research, an impact assessment and a cost/benefit analysis should be undertaken each time by the regulator/supervisor of the particular jurisdiction before any of these so-called effective approaches summed up in this draft, regardless of them being categorized as a ‘common,’ ‘innovative’ or ‘emerging’ approach. We urge the drafting team to clearly include this need for sound research, an impact assessment and a cost/benefit analysis in the introduction.” The federation went on to suggest that applying the same guidelines to multiple industries can be dangerous, and it suggested to the drafters that the language clearly define when various sectors should be considered equally and when they should be treated differently. Perhaps the most relevant comment to our market is the federation’s position on regulating companies of widely disparate sizes and revenue models. The federation told the OECD that “proportionality is a fundamental principle that should be taken into account by all regulators and supervisors every time they consider imposing requirements on the financial sector. Given the importance of this principle, we believe requirements imposed on the financial sector should be proportional to the size of the market player and the complexity of its service.” The federation concluded its comments by suggesting regulators should engage market players and industry representatives with direct knowledge of the market practices as key rules are written. This point is particularly important for emerging regulators to consider, as their markets are among the fastest-growing in the world. A thoughtful and democratic approach to market guidelines ought to be encouraged to ensure their continued strength. Nearly every developed economy continues to struggle with how to avoid another economic collapse, and the OECD has a strong role to play by issuing sound recommendations. It’s our sincere hope the suggestions to scale back its one-size-fits-all approach are heard loud and clear. This article first appeared in Leader's Edge magazine.

Workers’ comp in every state should carve out its medical line and relinquish it to Medicare. The respective statutory systems for indemnity benefits would remain. This scenario, albeit challenging in execution, would correct the cause of many systemic workers' comp ills. First, we must admit that the root of most WC problems lies in the delivery of medical care. Workers’ compensation medicine inhabits its own “bizzaro-world,” often lacking both clinical science and common sense. This is not the fault of most medical practitioners themselves, but more because of the pervasive manipulations, exaggerations and legal stretching of sensibilities that defy the clinical standards used in other venues. The ubiquitous, counter-intuitive flaw is that WC medicine often is used to expand a claim rather than provide a cure. Anyone in the WC business can agree to the following truths as just a sample of medically related frustrations: – Most any study performed shows higher costs and worse outcomes in WC medicine than in other settings. Common injuries take longer to heal when they are WC claims. – Hearing judges regularly disregard clinical opinions in favor of subjective evidence. A common judicial outcome is to award illogical progressions, allowing diagnoses to expand as problems progress through various body parts. – Causal relationship has an extremely low and speculative threshold when injuries are combined with chronic overlays and co-morbidities. – Chronic conditions are accepted as arising out of incredibly specious initial traumas. – Multiple surgeries and lifetime narcotic regimes are embraced in the face of perpetual and repeated failures to cure, all to the general detriment of claimants' health. – Various entities have profit streams directly related to churning medical care. – Most of the pendulum-swinging effort in statutory legal reform amounts to limited attempts to control medical systems already tainted by legal gamesmanship. Therefore, the results don’t always support optimal clinical perspectives or patient well-being. WC professionals may have a jaded viewpoint and accept this nonsense as part of the game. I ask you to consider a world where WC medical care was a non-issue. How much conflict and cost could be taken out of the system? Let’s take it another step and consider ridding the current system of Medicare Set Asides (MSAs). We all know MSAs and their surrounding requirements increase cost, require added resources and waste temporary total disability (TTD) money in process delays. MSAs are a hijacking of any given state’s ability to allow compromise settlements over unproven causal relationships. In effect, when no one has determined direct causal relationship, MSAs simply decree all future care be paid, in advance, as an addendum to a settlement. Another terrible dynamic of this hijacking is how Medicare profits from the wild abandon in WC medicine, as a litany of future responsibilities can be attached to a claim absent a clinical “reasonable and customary” test by which Medicare itself might never accept such treatment requirements. Through the MSA process, Medicare enjoys an exceptionally advantageous position with respect to WC. However, the playing field can be leveled by giving Medicare every claim from day one. There should certainly be a direct reimbursement requirement from WC claim payers to Medicare for related care provided. I argue that this scenario would be much less costly and more efficient and fair than the current big-picture scheme that is WC medicine. Here are a few practical thoughts in application that require no big changes: -Medicare uses its current rules for “reasonable and necessary” to approve all care and to formally conclude treatment. Disputes can be handled via existing channels available through Medicare. – Medicare uses its current fee schedules. – Medicare uses its current rules for determining “chronic” conditions as opposed to curative treatment. This is the arbiter for otherwise obstinate, litigated maximum medical improvement (MMI) arguments and sets the bar for drawing down the WC reimbursement requirement and transferring a case to group health if continuing care is necessary. Here are additional suggested changes to support the concept: – Questionable causation or responsibility for migrating diagnosis could be given a percentage likelihood that would be applied to Medicare reimbursements. Independent physicians from opposing sides could put forth opinions, and a review process could establish the percentage applied to the life of the medical case. For example, a clinical consensus decrees that aggravated shoulder pain is 25% likely as due to job-related issues, and therefore future Medicare reimbursements from WC are 25% of cost. – Extent of disability and permanency could still be determined by state-sanctioned independent medical exams (IMEs) and litigation process. The difference would be limits on the opportunity to exploit medical opinion, as Medicare would refer for these opinions, and aspects of Medicare’s rules and controls and requisite threat of sanctions would govern the providers. – Medicare would need to categorize WC-preferred providers with appropriate qualification in occupationally related medicine. – The ability to actually settle medical costs would no longer exist in any state. – New employer insurance products or funding mechanisms could be invented to cover “Continuing Medicare Reimbursements” on certain classes of long-term claims where indemnity is fully closed, as well as the sporadic one-off future claims that might arise as allegedly part of an initial WC claim, with a “claims made” type of trigger. No more MSAs. In conclusion, this concept would profoundly improve WC in four ways: 1) It provides a nationally accepted level of care to injured workers. 2) It brings clinical common sense to an otherwise specious and manipulated system. 3) It ends the oppressive impact of MSAs. 4) It saves an incredible amount of direct costs, frictional costs and resources while reducing litigation. This idea is radical, but, among the calls to revise the grand bargain, it does not totally explode the current state system. I say, let the debate begin!

I was only home from WCRI's annual conference a little more than a day when I saw a reminder that "simpler" systems often offer more effective solutions than more complex ones that are supposed to make our lives better. It was a lesson that overlays easily on the world of work comp with its all-too-complex and rigid structures. My wife and I were returning home from breakfast at a local restaurant Sunday morning when we stopped by a grocery store for a quick errand. We had taken my wife's car, and as we stopped she took the opportunity to try to reset the auto's clock, because Daylight Savings Time had "sprung us forward" an hour the night before. My wife drives a 2013 Mercedes Benz. It is by no means a top-of-the-line Mercedes, but it still has a plethora of electronic systems and services customary in a luxury car of this day. The car must be stationary to access the clock controls and other system features, so this was a good time to tackle this task. I watched as she scrolled through the menus on her digital display behind the steering wheel, looking for the correct one. After a few moments, she remembered that her previous car, also a Mercedes, controlled the clock via the main instrument display gauge. The clock control on this Mercedes, on the other hand, was to be found via a large knob on the center console. That knob controls a variety of commands on the audio and information center display to the right of the instrument panel. She decided very quickly that trying to find the clock control was a hassle and that she would just "get it later." Juxtapose this scenario with my car, a 2009 Hyundai Santa Fe. To reset the clock for springtime DST on my unassumingly low-tech ride I simply need to press a button. Once. The clock in my car, near the top center of the dashboard, has three buttons next to it. One resets the clock to the next increment hour. The other two handle both hours and minutes on the clock. Pushing either adjusts the appropriate time segment with ease. Apparently, the Koreans who engineered my car, and the Alabamians who built it, are not as concerned with my safety as those overprotective Germans. I can change the clock whether the car is moving or not. I could be careening down the interstate at 90mph, cellphone wedged between my ear and my shoulder (no Bluetooth) and holding a doughnut firmly clenched in my left hand. A quick reach and push of a simple button still accomplishes on my humble Hyundai what others can only dream of -- an automobile clock set at the correct time. Admittedly, fall is more difficult, as I have to hold that button a few seconds while it scrolls forward 11 digits to actually set the clock back one hour. No AM or PM in my car, baby. The Koreans know I can tell the difference. Metaphorically, the workers' compensation industry, born of the grand bargain in 1911, started life as a Hyundai but has since evolved into a Mercedes. Nothing in comp is simple anymore. At the Workers' Compensation Research Institute Annual Conference, attendees were treated to a myriad of statistics and analysis related to a variety of topics in workers' comp. We learned that despite complex legislative efforts to control outrageous abuses by physicians who dispensed their own drugs, doctors in Illinois simply changed the dosages to bypass the law. We learned that states that set low fee schedules see increased costs because of more expensive office visit codes as well as an increase in doctors office visits. There were many similar topics and discussions, from California's independent medical review (IMR) process to Florida's exclusive remedy challenges. The entire conference highlighted the complexities of managing a process-intensive system that still at times manages to lose people through a somewhat tangled safety net. It is another perfect example of how complexity and process can eventually stumble and collapse under their own weight, and every attempt to fix the previous crisis simply adds more layers of complication, furthering the potential for failure and disappointment. Sometimes, simple is better. Pay doctors a fair wage, and reward the ones who perform the best by using them more often. This would stop much of the gamesmanship we see in the pricing of medical services today. Improve and facilitate communications between the employer and the injured worker. Better communication between these primary parties can reduce lost time and litigation. Train adjusters well, keep their workload reasonable and let them actually manage a claim. This would minimize dependency on a plethora of specialty firms, each performing specific tasks that empowered adjusters of yore used to handle. Streamline regulation, making the care of the injured the most important task rather than focusing on useless and resource-sucking paperwork. A simpler, focused effort in these areas would fairly quickly see improved results for all the players in comp that really matter. I can speak personally of the benefits of simplification. The car I owned prior to my Hyundai was a BMW Z4 Roadster, with sequential manual gearbox transmission. While it was an incredibly fun car to drive, I never could change the stupid clock. Setting it in that car was not dissimilar to following a pre-flight checklist for the space shuttle. It was much easier to leave it alone and let it only be right for 1/2 of the year. But while getting it right half the time may be acceptable for the clock in your car, it is an abysmal concept where injured human beings are concerned.

Too few companies have a customer strategy, let alone a customer-insight (CI) strategy. At least, that's my experience. In fact, many business strategies that I've seen, which seek to pepper their presentation with customer language, are really channel strategies or product strategies that reflect the silos in that business. This is unfortunate, as most CEOs would acknowledge the critical importance of having their business understand, acquire, satisfy and retain customers (ideally, converting them into advocates). But perhaps the lack of customer insight in strategies reflects that may boardrooms have not had an empowered and articulate customer leader (or, better still, CI leader) to identify the need and drive the change. As a small contribution to fill this gap, let me share a few reflections on what I have found helpful to consider when creating a customer-insight strategy. At its simplest, strategy is just a series of decisions about "what you are going to do." This mindset can help avoid too much theorizing with pretty diagrams and ensure your strategy leads to an implementation plan that can be executved. As a simple framework, it can help to consider three overlapping sets that you need to consider for a CI strategy: Strategic Alignment: Although a CI strategy can inform and guide business and marketing strategies (from an understanding of consumers, your target market, their perceptions, unmet needs and channel usage), normally those exist prior to creating a CI strategy. So, a first priority is to ensure alignment. How can customer insight help achieve the goals of the business strategy? What does the business need to understand better to deliver the marketing strategy? How can the work that aligns best with top strategic priorities be prioritized for the CI function. Is there other work that the CI function is doing that can be stopped or reduced given its low alignment with strategic priorities? All these elements should be thought through to decide what is included within CI strategy. Your business and marketing strategy have likely been shaped, at least in early stages by PEST (political, economic, socio-cultural and technological), SWOT (strengths, weaknesses, opportunities and and threats) and other tools to analyze internal and external factors. Similarly, in summarizing what the CI strategy should be (aligned to business and marketing strategies) it is useful to see what use of CI is working for others businesses (here, lessons can often by learned outside your sector) and summarize what CI work has been most effective previously for you (on the basis of commercial return and improved customer feedback). Both of these approaches should help identify priority work areas where CI can make a difference and help deliver the business and marketing strategies. Operational Effectiveness: This is all about organization and processes. How does the CI function operate? Once again, it is useful to both look internally, capturing what has really happened already, and externally (this time for best practice models). Given the relative immaturity of CI in academic terms and lack of common language or focus from "marketing experts,"' it can be hard to find the textbook answer for the customer insight best practice model. However, I have found a few of the benchmarking models used by technology research companies and marketing professional bodies useful and have produced my own (on the basis of 13 years experience in creating and leading such functions). However you come by a best practice model with which you are comfortable, your next step should be the familiar approach for gap analysis. Summarize your current practice, compare and contrast with the best-practice model and then prioritize the gaps you find. Prioritization here needs to be informed by what you will be using your CI function to achieve (as summarized in the strategic alignment section). This review and gap analysis should consider not just the processes for getting different items of work delivered but also the organizational structure of the team. Despite some leaders claiming the structure does not matter if you have a unifying vision and the right attitude, all my experience teaches me that it does. Human beings are inherently tribal, and the quality of CI output is strongly affected by inter-disciplinary cooperation. People Leadership: That mention of departmental structure brings us neatly onto focusing on the people in your CI team(s). Too often, strategy documents, even if they manage to translate the conceptual into the practical, fail to then consider the people side of change. To deliver the priorities identified in your strategic alignment review requires not just appropriate structures and effective processes but also the right people and culture. A good place to start can be a review of the current people in roles, comparing them with the ideal roles and skills required to deliver the work needed. Such a review should seek to consider people's generic competencies and wider skills than they may be asked to use in current roles, as well as critically assess their attitude and fit with the team. But beyond just the right individuals, success will depend on those people coming together to form effective teams, and that is more about culture than what is written down. I like to think of culture as "what happens 'round here when people aren't being watched." Various approaches have been tried to impose or encourage the culture wanted in a team, but I've found little works as well as empowering the people themselves to create the culture in which they want to work. An effective people leader is needed, who can communicate a clear vision and make decisions, but the leader will often be most successful when working with suitably skilled individuals to together define the team culture they want and how that can be encouraged. Truly listening to the wisdom of those doing the work, recognizing and rewarding the behavior sought and giving time to developing people and fixing environmental irritants will all encourage this. None of this is easy. But being in a position to articulate to your team and your boss and the board a coherent customer-insight strategy (which explains how it enables business objectives, operates effectively and gets the best out of the people in the function) can be powerful.

Recently, my 80-something mother bought an iPad to replace one of the first models, which is now obsolete (can’t upgrade the iOS!). So, though she is an always-with-some-trepidation user, she’s no Luddite. After her second day with the new device, she called me with some alarm to say that someone named Siri was trying to hack into her iPad. This got me thinking about big data and the role of the insurance agent in the future. My thinking goes something like this…

Insurance Agent of the Future

Insurance of the future will be beyond indemnification for losses (at an actuarially fair price, of course) and will include loss reduction in some way, whether through direct action or indirect advice.

Let’s think about home automation and monitoring systems, a.k.a., the connected home, or "telematics for the home," delivered through companies such as Keen, SNUPI and Revolv. Think thermostats, video cams, carbon monoxide and fire/smoke detectors, storm shutter and roof single sensors, refrigerator and freezer sensors, door lock sensors, etc.

The capabilities are going to be integrated and will involve big (data). Some company – maybe insurance companies, maybe those giant B2C companies like Google and Amazon, maybe some others – will take all that data and present it back to the consumer in an intelligent manner.

Here is where loss reduction becomes very interesting. Companies could take direct action through automated activation of alarms and shutdown of systems when storms are approaching. Indirect advice might mean notifying a homeowner of unlocked doors, foot traffic in the house and refrigerator doors opening and closing.

Where does the agent come in? Maybe Google or Amazon and ADT will just get this all to simply work: Download the app, and it tells you what to do. But maybe the consumer will want some help with all this data and all this activity: what filters to tighten, what sensors to de-activate and what data is needed to get the right coverage at the right price. Maybe the Geek Squad needs to morph to the Home Monitoring Squad. And the Home Monitoring Squad sure sounds like the possible insurance agent of the future – tech-savvy, risk-savvy and comfortable conversing with 80-year-olds.

It was an event maybe even more anticipated than Neil Armstrong’s Moon shot in 1969. I had never tuned into one before, yet there I was, sitting in my pajamas at 1 a.m., frantically trying to get back onto the streaming podcast that my iPad had just dropped, as millions of other nerds the world over were trying to do the same thing. Apple’s product announcement event on Sept. 9, 2014, had drawn unprecedented interest. I certainly was expecting Apple to “do it again” – you know, change the world in a subtle yet pervasive way, as I am sure many others struggling to get onto the live webcast also believed would happen. After all, the company that Steve built had done it with iTunes, with the iPhone and with the iPad. And now we all wanted to see if Apple’s first wearable device – the Apple Watch, was going to change our lives in the same way. Well, we definitely saw something that early morning in September, but the realization of the promise still lies ahead, with the first retail delivery of Apple Watches not until late April 2015. What is certain is that Apple has successfully moved the idea of a connected wrist health and fitness tracker from the niche arena of health-conscious individuals to the mainstream “Joe Public.” Interestingly, even if Apple falls short this time, it has set in motion a great race with Microsoft, Google, Samsung, Fitbit and many others to fulfill and surpass the vision that we all saw in September. In 2014, world-wide revenue from the sale of wearables was roughly $4.5 billion, but, in 2015, expectations are sky-high. Some experts predict sales will increase as much as three times, fueled in the most part by the Apple Watch. So why are wearables a good thing for insurance? The rise of wearable fitness trackers as part of corporate wellness programs has been an emerging trend over the last 10 years. In the past, enlightened companies were giving out Fitbits to help employees track their own fitness. More recently, companies have been trading program participation and fitness data captured from such programs for discounts on their corporate health insurance. For example, Appirio, a San Francisco-based cloud computing consultancy, was able to get a 5% discount ($300,000) off its insurance bill in 2014, while BP America distributed around 16,000 Fitbits to employees as part of an integrated wellness program and claim to have put a brake on corporate healthcare cost increases by slowing them to below the U.S. national growth rate in 2013. A key ingredient to the success of these programs is the engagement of the members, so that healthy behaviors are encouraged and rewarded. In the BP example, the Fitbit data was easy to “gamify” because of the connected nature of the device. Members competed on a number of challenges, including the “1 million step” challenge, simply by wirelessly “syncing” their devices. Cory Slagle, the spouse of a BP employee, was able to trim $1,200 off his insurance bill through participation in this program -- dropping nearly 32 kilograms and 10 pants sizes and reducing his high blood pressure and cholesterol back to normal range in just 12 months. Vitality of South Africa has recognized the importance of a holistic health and wellness program for well over a decade and has built up an impressive array of statistics, including: --Participation in health and fitness programs reduces health claims by 16% --Logging fitness activities reduces risk by 22% for the unhealthiest category of participants --Participating members are as much as 64% less likely to lapse on their insurance as non-participants are --Participating members have as much as a 53% lower mortality rate than non-participants The only trouble is that participation in such programs remains minuscule, with opt-in rates in some cases of just 5% for those eligible to join. Despite the programs’ value propositions being augmented with an affinity network of providers supplying goods and services at a discount for participating members, opt-in rates and persistency remain problematic. A recent survey by PWC found that, if the connected wearable device was free to the member, then about two-thirds said they would wear a smart watch or fitness band provided by their employer or insurer. Cigna completed a connected wearable pilot in 2013 involving 600 subjects, which indicated 80% of the participants were “more motivated to manage their health at the end of the study than at the beginning.” In the U.S., United Health, Cigna and Humana have already created programs to integrate connected wearables into their policies, to create reward systems based on data sharing. In one innovative program, a “wager” penalty system was found to be three times more effective in motivating healthy behavior than the typical rewards these programs offer. The “wager” involved the member's signing up to achieve and then maintain reasonable fitness targets over the course of the year to avoid having the cost of the health screening be deducted from their salary. A key hurdle to overcome with the data generated from connected wearables is privacy and security. Individuals want to know what insights are being generated from the data being collected and want to selectively share with the program based on the perceived value they get back. They also need to know that the data continues to be secure and private once shared. Apple is working this angle through its HealthKit, which is positioned as the data control room for consolidating and securely sharing health- and fitness-related data to selected parties. There are already in-the-field health trials in progress with Stanford and Duke universities that are being powered by HealthKit. Google, Samsung and several others have also launched similar competing frameworks, so the data privacy issue is understood and being addressed by the technology companies offering products in this space. I want to mention an innovative, data-driven, life insurance program that currently doesn’t use any wearables but easily could. AllLife of South Africa provides affordable life and disability insurance to policyholders who suffer from manageable chronic diseases, such as HIV and diabetes, and who sign up to a strict medical program. Patients get monthly health checks and receive personalized advice on managing their conditions. Data driving the program is pulled directly from medical providers, based on client permission. If a client fails to follow or stops the treatment, then the benefits will be lowered or the policy will be canceled after a warning. The company assesses its risk continuously during the policy period, contrasting with the approach of other companies, which typically only assess risk once, in the beginning. This approach allows AllLife to profitably serve an overlooked market segment and improve the health and outlook for its customers. It plans to cover more than 300,000 HIV patients by 2016. The video of AllLife’s CEO, Ross Beerman, on YouTube is quite inspirational, and I recommend you see it. He says, “Our clients get healthier just by being our clients.” He also mentions the challenges of building an administration system to support AllLife’s customer-engagement model. In summary, several intersecting trends have conspired to make this the perfect time to consider the launch of insurance programs and products powered by the new insights from the data being made available through wearable fitness and health trackers: The whole fitness and healthy lifestyle perspective has entered into the mainstream culture Devices like the Apple Watch have become fashionable, objects of desire The data from these devices is easy to capture and share – no forms to fill in --The data is of clinical quality, in at least some cases, and therefore useful for actuarial models --Insurers have already started to jump on the idea of “telematics” for humans for risk pricing --Feedback from this data is able to positively modify behavior to reduce health risks and improve the quality of life for those participating I am still undecided if I’m going to be up at 1am again, this time outside the Apple Store, waiting for the Apple Watch to go on sale. However, the line outside the Apple Store that night could be very fertile ground for agents selling polices driven by the data these new devices will provide, if only companies act now and get their programs in place. Thanks for reading, and see you in the gym :-) This article originally appeared in the January 2015 edition of Asia Insurance Review.

Insurance fraud, that ever-present nemesis of claims professionals, has a new opponent. A technology triple threat—the Internet, extensive and accessible databases and the pervasiveness of social media—has come of age, and the result is an increased exposure of workers’ compensation fraud and a rise in prosecutions. As with many industries, the tools used in fighting fraud have evolved over the years, and today’s high-tech resources are completely different from the tools employed a mere 20 years ago. In the pre-Internet era, employers and insurance industry professionals who suspected potential workers’ compensation fraud had limited, and often expensive, options to gather evidence. Even the initial paperwork was more cumbersome. The adjuster would first complete a hand-written referral form requesting investigative services, which would slowly pass through the fax machine to materialize in the investigator’s office. That’s much different from today’s data integration of claim systems with investigative partners, where a click of a button auto-fills the referral form, and the complete claim file is populated into the investigative company’s web-based case management system. For surveillance conducted pre-Internet, the investigator would review the Thomas Brothers map, load the large VHS video camera and extra batteries in the van and drive to the subject’s last known residence to roll the dice on filming the correct person. Employers were not able to email photos of employees, and there were no online social networks to locate vacation photos and other important information. Going From Print and Tape to Digital Today’s technology allows those fighting fraud to conduct a more comprehensive pre-surveillance investigation than they could have been imagined just a few years ago. Mapping technology provides a clear visual of the subject’s residence and surrounding neighborhood. This allows the investigator to create a detailed surveillance plan including routes, local and covert tail opportunities and other strategies. Online database searches, Department of Motor Vehicle records and social networking searches provide a plethora of information. Additional tools such as GPS tracking and video streaming also have improved the success rate of surveillance. Today’s video cameras do not resemble their older brothers from the '90s. The heavy cameras of the past were best used with a tripod to hold the weight, making quick maneuvers difficult. Getting out of the vehicle to obtain film from an on-foot pursuit was extremely challenging. A large duffle bag with a hole cut in the end for the lens was hard to keep clandestine approach. And covert cameras lacked the quality needed to prove identity. Today’s compact, powerful, digital HD video cameras provide high-quality video and fit comfortably in one hand. Additionally, current covert cameras are undetectable—the camera lens can easily be part of a hat, a shirt button or a keychain. Significantly, these tiny video cameras can capture clear footage almost on par with film obtained using a standard video camera. In addition to the VHS video camera, the tools of the trade back then included a pager, a heavy cellular phone with a large antenna, a stack of phone books, a shoebox full of maps, several proven pretext scenarios and, most importantly, a Rolodex. Information that we now find on the Internet certainly was obtainable before the Internet-era, but it had to be acquired with different and often creative methods. Digging for Information While investigators today have Internet connection in their vehicles and can quickly conduct database and social network searches while onsite, the pre-Internet investigator’s most valuable tool was relationships, as information was shared by people, not technology. The investigator often had little information about the subject upon initiation of the investigation and gathered details the old school way—by digging. Investigators could be found reviewing records at the voter registration office or scanning microfiche at the court to ascertain critical information. They spent a lot of time standing in lines at public agencies and searching through endless records stored in large ledgers, microfiche or index card catalogs. The information found in public records was invaluable—current and former addresses, real property data, encumbrances, marriage licenses, divorce records, birth certificates, bankruptcies, criminal records, traffic tickets, tax liens, civil lawsuits, evictions, business licenses, professional licenses and more. While this information was vital, it was tedious work retrieving it, especially if the subject had a common name or a maiden name or aliases. Successful investigators had to be not only good at investigation, they also had to be successful at establishing connections to build a Rolodex of contacts. An effective investigator leveraged strategic connections to successfully and quickly gather information. Making connections with the people who worked in the records departments of courts, law enforcement agencies, recorder’s office, voter registration, licensing bureaus and the like, then gathering phone numbers that rang directly to desks, was essential to efficiently obtain vital information. Likewise, networking with fellow investigators in other areas to trade resources saves time. Gaining Public and Private Details Public records have always been a critical source for identifying information, financial information, business records, criminal records, civil litigation records and the like. However, those records did not provide the personal insight that we can find on the Internet. Today, a search of social networking can yield information, insight and often photographic evidence of a subject’s habits, activities, interests, schedules and behavior. If obtained legally and ethically and stored appropriately for chain of custody, this online evidence can be submitted to medical providers and the Workers’ Compensation Board and used as evidence in Superior Court, including in criminal cases of workers’ compensation fraud. To learn personal information pre-Internet, one needed connections and creative sleuthing talent. Delivery companies, utilities, contest and sweepstakes promoters, magazines, debt collection agencies, credit reporting agencies, retail and catalog ordering companies often made additional revenue by selling their customers’ personal data. Today, calling people to obtain information has been replaced with Internet searches. Several companies provide database services, including instant access to credit reporting agencies, public records, utility company records and other information. Now, what previously took many hours, if not days, of phone calls and in-person searches and cost a significant amount is accomplished in mere seconds. Pretexting—the practice of presenting oneself as someone else to obtain private information—is one strategy that has carried over from pre-Internet days. Indeed, it was all but impossible to conduct a successful investigation without it before the Internet, and it remains useful today. Pretexting is legal in many states, and investigators have historically used it to obtain needed information. A successful pretext call results in a willingness by the subject or other source to share information and, if done correctly, leaves no footprint behind, so the people are never aware they spoke to an investigator. The successful investigator uses a combination of old and new to navigate today’s complex world of insurance fraud. Pretexting still works in some cases, relationships always will matter and technology continues to evolve and to provide even better data. Workers’ compensation fraud will, unfortunately, always be with us. However, old, new and yet-to-be developed techniques will bring that fraud to light, resulting in a better system for us all. See Darlene's interview here.

The traditional school of thought since the Americans with Disabilities Act (ADA) was enacted in 1990 is that it did not apply to state workers' comp cases because they involve temporary disabilities and work restrictions. Claimants were not considered "qualified individuals with a disability" under the ADA. Even if the ADA provision for a "reasonable accommodation without undue hardship" is to be taken into consideration, the process would not begin until the claimant reached maximum medical improvement (MMI). But informal EEOC guidelines released in December 2014 stated that these traditional understandings may not be legal.

The EEOC release stated that it is "not true" that MMI should be considered the trigger for ADA-related protections for employees and obligations for employers. Employers must begin the ADA interactive process for return to work (RTW) much sooner than commonly thought. The EEOC is saying that workers' comp and the ADA process are to run simultaneously, not sequentially. In addition, the worker must be an active participant in the process. This is a major surprise to many in the industry.

I have been a proponent of using "the spirit of the ADA" to implement return-to-work practices in workers' comp programs for 25 years. (See previous ITL article, "Return-to-Work: A Success Story," June 25, 2014.) However, these new "interactive process" guidelines may change the whole practice of RTW in workers' comp because most employers and their third-party administrators (TPAs) or insurers typically postpone attempts at a reasonable accommodation until the claimant reaches MMI. That may now be construed as a violation of employee rights and employer obligations under the ADA.

In addition, the EEOC guidelines give a very broad definition of disability and when it applies under the ADA. The EEOC spokesperson said the ADA applies "all the time" and "as soon as notified" when "a medical condition has the potential to significantly disrupt an employee's work participation. . . . The only relevant question is whether the disability is now, or is perceived as potentially, having an impact on someone's ability to perform their job, bring home a paycheck and stay employed."

That is a mouthful to swallow and think about. The ADA would apply if the disability is "perceived" as having an impact on the ability to perform a job. Perceived by whom? The employer? The employee? The physician? What physician?

What does this mean for employers?

The EEOC stated that its biggest concern is the employee who has a disability but who can perform the essential functions of a job with a reasonable accommodation. The cause of the disability is considered irrelevant under the ADA. It will now be very difficult for employers to say that a worker is not a "qualified" individual under the ADA because the person obviously held the job prior to the disability.

The EEOC stated that everyone, including treating physicians, TPAs and employers, should "keep that in mind" but that only the employer is accountable for complying with the ADA. Treating physicians and employer vendors who fail to communicate with employers during the "stay @ home" process may be exposing the employer to increased risk and liability, and the EEOC spokesperson said this failure would be particularly troublesome if a treating physician who is picked by the employer doesn't tell the employee about adjustments that might allow her to work. The employer may be liable for failing to provide that accommodation even if not properly passed along. The EEOC spokesperson went on to say that physicians and vendors should be educating employers. But who, may I ask, is educating the physicians and employer vendors?

How should employers react to these EEOC process guidelines for workers' comp and other non-occupational disability programs? Employers should embrace them!

Most that is truly considered workers' comp managed care and RTW best practices are encompassed in these interactive guidelines: prompt, high-quality medical care followed by 24-hour contact between workers, treating providers and supervisors. Safe return to work, with or without reasonable accommodations, should be the goal from day one and documented in each case, even without intervention by the EEOC.

Sebastian Grasso, CEO of Windham Group in Manchester, NH:

sgrasso@windhamgroup.com

which specializes in "failed return-to-work," agrees and argues that the EEOC action should be a "wake-up call" for employers. Grasso, like several other industry experts interviewed for this article, said that in his 25-year career in the RTW business his employer/insurer clients have never brought up the ADA in workers' comp cases. He said the two problems faced on a daily basis in the workers' comp industry that severely hamper RTW efforts are erroneous job descriptions and inflexible employers who won't take injured workers back unless they are "100%." This traditional mindset and passive approach to RTW may now be considered an ADA violation, so employers and insurers may have to re-think their RTW policies and procedures.

Grasso stated; "We get injured workers back to their original jobs; it's what we do every day. It's the right thing to do; it's non-adversarial and benefits all the players in the process." This approach appears to be both within the spirit and now actual guidelines of the ADA, according to the EEOC.

Ted Ronca (medsearch7@optionline.net), a leading workers' comp and disability attorney based in New York, also stated that he never saw the ADA brought up in a workers' comp case in New York in the past 24 years. Ronca also feels employers should "champion" the new approach for workers' comp RTW programs. He recommends the first thing for employers is to establish job requirements and bring the employee into these preliminary discussions. Ask the worker for his input on reasonable accommodations and document the discussion.

Back when the ADA was enacted in 1990, many believed a slew of litigation would result from workers' comp cases. This has rarely, if ever, happened. Most experts I have spoken to are not aware of any cases, but the original fears may now come to fruition. As Ronca noted; "75% of the cases in the New York work comp system involve cases where the claimant's attorney is claiming total disability and seeking a lump-sum award." Getting that injured worker back to work is not on the claimant's attorney agenda but should be on the employer's.

Employers should not fear the ADA but embrace it. The ADA has built-in protections for employers such as that any accommodations must be "reasonable without undue hardship." This means significantly difficult or expensive. In addition, employers are not required to eliminate or reduce the essential functions of a job even temporarily. The EEOC is simply saying that employers may choose to reduce job demands and productivity expectations on a case-by-case basis and that no blanket policy is appropriate.

However, the EEOC goes on say that the ADA cannot be used to deny a benefit or privilege to which an employee is entitled, such as time off under the Family and Medical Leave Act (FMLA), workers' comp, disability, sick leave, accrued vacation or any other leave and benefits. The EEOC considers the ADA "civil rights for people with disabilities."

I just loved the EEOC comment that an employer's stay @ home policy is not a reasonable accommodation. Not only is an interactive process the right thing to do for disabled workers, it will save money, improve productivity and protect employers from potential ADA violations and obligations.

It may be time to rethink your return to work program. It's about time!