Tag Archives: workers comp

We Are Open for Business; Now What?

Established continuity plans are an essential part of a business’ reopening in a post-COVID-19 world. Expectations for success continue to rise as more businesses reopen with safety as a top priority. With a growing list of resources and recommendations, many employers are wondering where to start.  

We partnered with the Public Agency Risk Management Association (PARMA) for our latest Out Front Ideas with Kimberly and Mark webinar, where three special guests joined us, to discuss employer considerations for returning to a physical workspace:

  • Tim Karcz, senior risk manager | California Joint Powers Insurance Authority
  • Traci Parke, partner | Burke, Williams & Sorenson
  • Chuck Pode, risk manager | county of Ventura

Physical Workspace

There is an abundance of public health recommendations for reopening safely, but businesses are left to develop their own policies and practices to implement these standards. The Centers for Disease Control and Prevention (CDC) has outlined how to create a plan for implementation, including measures for separation, social distancing and sanitizing. Many public entities are requiring a site-specific plan addressing these issues before reopening. One of the best ways to get started is to conduct a walkthrough of the facility, acting as one of the employees. Before completing the walkthrough, you should know what day-to-day activity looks like, where to make necessary adjustments and what the expectations are for both employees and custodial staff. Be open to changing and revising the plan constantly and communicating the changes with employees.

Your continuity plan should include:

  • Engineering controls, like barriers and social distancing measures.
  • Administrative controls, like staffing level changes.
  • Personal protective equipment to control transmission, like masks.
  • Cleaning and disinfecting procedures.
  • Employee training to address check-ins, health screens, social distancing and usage of personal protective equipment (PPE).
  • Employee-specific guidelines to address when an employee feels ill, or if someone in the person’s household is feeling sick. 
  • Updated data security measures.

See also: Access to Care, Return to Work in a Pandemic  

Safety Considerations

An excellent resource for preparing a safe return to work is OSHA document 3990-03: Guidance on Preparing Workplaces for COVID-19, which follows standard regulatory requirements. There are six key elements listed for implementing a successful reopening model:

  1. Develop an infectious disease and response plan. Ask your business partners if they have any resources readily available. There are resource templates available for what applies to your industry, but OSHA is encouraging more personalized plans to meet your organization’s needs.
  2. Prepare and implement basic infection prevention methods. These include refraining from physical contact, using a key or pen to open doors, throwing away used tissues and not touching your face, mouth or nose with unwashed hands. Make these guidelines inclusive to all employees within your industry. 
  3. Develop policies and procedures for prompt identification and isolation of sick people. Encourage employees to self-isolate if they are experiencing symptoms and have a plan in place if someone exhibits symptoms within the workplace.
  4. Develop, implement and communicate about workplace flexibilities and procedures. Talk to your employees about their concerns regarding leave, safety, childcare and any other issues that may arise. Flexibility with current policies is critical to continued success. 
  5. Implement workplace controls. Engineering, administrative and protective equipment measures all need to be addressed. 
  6. Follow existing OSHA standards. Many existing rules apply to current prevention methods and should be included as part of any continuity plan. 

OSHA also suggests classifying worker exposure to COVID-19 into four risk categories: very high, high, medium and low. The guidance document has specific definitions for each:

  • Very high risk includes those exposed to known or suspected COVID-19 patients.
  • High risk includes those exposed through medical services, like first responders. 
  • Medium risk includes those possibly exposed to someone who may be infected, but may not know they are infected.
  • Low risk includes the majority of employees, who are not required to be around those who may be infected but could be exposed at some point.

ADA Considerations

As COVID-19 makes a more significant impact on the day-to-day lives of employees, compliance with the Americans with Disabilities Act (ADA) may pose a greater challenge for employers. The Equal Employment Opportunity Commission (EEOC) has published guidance on complying with the ADA with COVID-19 in mind. A few of the commonly addressed questions include:

  1. How much information can an employer request from someone who is sick to protect the workforce? Typically, the employer cannot request details of the illness, but, because of COVID-19, the employer can request that the employee disclose any symptoms related to COVID-19. The employer must keep this information confidential. 
  2. Can employers take employee temperatures or require health screens before entrance into the workforce? Yes, although the screening can present confidentiality issues because there is no real playbook for how to conduct the health screens. If implementing this process, it is a good practice to disclose plans to employees before they return to the workplace. Specific states will require a notice of collection before screening employees. This information will also need to remain confidential. 
  3. What can we do to protect our high-risk employees or any employee who seeks health-related accommodations? ADA duties and obligations still apply to provide accommodations for anyone with a preexisting condition or disability that makes the person particularly susceptible to COVID-19. Think about the individual risk factors that these employees may face in the workplace. Accommodations may vary depending on the essential functions of their day-to-day job. Get input from the employee and the person’s manager to protect them. Telecommuting is highly encouraged by the EEOC and should be seriously considered if it does not cause undue hardship for the employer.

See also: Strategies to Reopen Your Business Safely  

To listen to the full Out Front Ideas with Kimberly and Mark webinar on this topic, click here.

Strategies to Reopen Your Business Safely

As states reopen, businesses will have to grapple with the challenges of creating a safe environment for both workforce and consumers. Employers have to address a range of issues, like how to mitigate workplace transmission of COVID-19, what workforce challenges to prepare for and how to demonstrate to consumers that they can safely shop at the business.

I enlisted the help of the following three public health experts to discuss best practices for reopening businesses safely:

  • Dr. Scott Benson — associate professor, Division of Public Health and the Division of Infectious Diseases | University of Utah
  • Dr. Steven Lacey — professor and chief, Division of Public Health | University of Utah School of Medicine
  • Dr. Kimberley Shoaf — professor and associate chief, Community Engagement | University of Utah

Facility Hazards

Water intrusion and mold. If a building has been left unattended or with a skeleton crew, water intrusions may go unnoticed and result in mold growth. A certain amount of heat load is typically expected with people in the building, and, without it, water and lack of heat can contribute to mold. 

Water systems. Most large buildings have cooling towers and other evaporative cooling systems. With water not circulating in these systems, naturally occurring legionella bacteria can grow. Turning systems back on can create exposure to the bacteria. Talk to facilities personnel about purging and disinfecting water systems before reactivating. 

HVAC systems. Higher ventilation rates, zone pressurization of fresh air and systems that run longer can help protect employees. Talk to the building manager about optimizing airflow patterns and directional flow to keep contaminated air away from employees. Enhancements such as upgrading to MERV-13 filters to capture viral particles, ensuring that relative humidity ranges between 40% and 60%, will further control exposures to the virus. 

Cleaning and disinfection. Despite the use of these terms interchangeably, there is a significant difference between the two. Cleaning uses a detergent to remove dirt physically from the surface but does not kill all germs. Disinfection is the destruction of those germs at a high percentage, rendering them incapable of reproducing. For guidance on the most effective disinfectants in fighting the SARS-CoV-2 virus, refer to the EPA’s List N

Preparation for a Returning Workforce

Establish an Infectious Disease Preparedness and Response Plan. Characterize potential routes for exposure, task-specific risk factors, available control strategies and a plan for communicating expectations with employees and customers.

Follow location-specific guidelines. Use resources like federal, state and local guidelines to determine the parameters for your office’s readiness. States vary significantly in terms of their guidelines for reopening, so, if you have locations across the nation, be aware of the differences. Some locations will require a smaller percentage to return to a physical workspace, so have a phasing plan prepared.

See also: Firms’ Priorities During Pandemic  

Understand employee risks. Exposure potential will vary greatly depending on job type and other factors. Follow CDC guidelines, and communicate with your HR team to understand which individuals may be at higher risk. 

Know how to handle a sick employee. If someone comes to work sick or falls ill while at work, you need to have a plan to safely isolate and move them out of the workplace while maintaining their confidentiality. Provide onsite responders with the appropriate training and personal protective equipment (PPE) to protect them from potentially sick employees. 

Understand changes to sick leave policies. The Families First Coronavirus Response Act (FFCRA) extends coverage under certain circumstances for employers with fewer than 500 employees but more than 50. If your organization is not a part of the FFCRA coverage, flexibility with paid sick leave and extended family and medical leave is crucial to your response. 

Prepare your communication strategy. Communicate your pandemic response to your employees and the general public. Use resources like social media channels, call centers, text messages, emails and recorded video messages to make your response widely known.

Protecting the Workforce and Consumers

Worker social distancing. For this to be effective, you need compliance from your workforce. Communicate with your employees why it is critical to protect their health as essential members of the business. The goal should be to enable a minimum of six feet of space between individuals. To make it easier to comply, create gender-neutral and single-occupancy bathrooms and close off common gathering areas. 

Consumer social distancing. Just like with your employees, communication with consumers is key to the effectiveness of social distancing. Use passive prevention through design and engineering controls, like arrows on flooring and easy-to-read guidance. Use preferred mechanisms like contactless delivery and curbside pick-up. Separate your entry and exit with barriers between them, directing traffic away from each. Create physical barriers (cough and sneeze guards) at high-contact points, like checkouts and drive-thrus, and limit credit card or cash transactions and encourage no-touch checkouts.

Personal protective equipment (PPE). Providing necessary PPE to your workforce is crucial to their safety, but it is essential to understand the different types. N95 respirators protect the wearer and should be reserved for healthcare workers at the highest risk of exposure because they are in short supply. Surgical masks protect those around the wearer and are generally used by healthcare workers and other frontline workers at higher risk of exposure from their job. Cloth face coverings help slow the spread of the virus, and the general public is encouraged to wear these. 

See also: Access to Care, Return to Work in a Pandemic  

Hand hygiene. Make it easy to maintain hand hygiene by stocking paper towels in the bathroom, keeping a trashcan close to the door to discard paper towels and making hand sanitizer readily available. 

Employee education and communication. Provide your employees with the information they need to comply with guidelines. Ensure all information complies with OSHA guidelines and is consistent. Explain the benefits to your employees and consumers.

To listen to the full Safety National webinar on this topic, click here. View the complete library of Safety National’s webinar topics here.

Addressing the Rise in Topical Prescriptions

Across the country, healthcare providers are shifting their prescribing practices in response to the opioid epidemic. According to IQVIA Institute’s Medicine Use and Spending in the U.S. — A Review of 2018 and Outlook for 2023, prescription opioid volume declined 43%, from 246 billion morphine milligram equivalents in 2011 to 141 billion in 2018. Many factors have driven the decline, including news media coverage, state and federal initiatives (e.g., prevention, intervention, treatment and recovery support), the Center for Disease Control and Prevention’s 2016 guidelines for prescribing opioids for chronic pain, healthcare provider education, lawsuits against companies that manufacture and distribute opioids, the arrest and prosecution of healthcare providers and efforts taken by insurers to reduce opioid prescribing.

Although there has been significant progress in some ways, unintended consequences periodically emerge in the fight to reduce opioid dependency and addiction. For example, in early efforts to address the emerging opioid epidemic, law enforcement officials aggressively targeted and shut down opioid pill mills overnight. This abruptly left many opioid-dependent patients without access to opioids, resulting in a spike in heroin use. As another example, several states and private companies have successfully implemented policies to limit opioid prescriptions on initial fills to seven days or less under specific circumstances. In response, some healthcare providers have avoided these limitations by prescribing 30 days (or more) of pills in the shortened time frame. Lastly, as prescribers look for alternatives to opioids, the healthcare industry has seen a dramatic increase in the use of topical and compounded pain relievers. This has increased the cost of providing care in a healthcare system already struggling to contain medical costs. Despite the increased spending, these options often fail to demonstrate a corresponding desired therapeutic outcome.

This article will share some strategies being used by insurance companies to help injured workers receive cost-effective and therapeutically effective pain management drugs, with the ultimate goal of returning them to work and more productive lives.

Topical vs. Compounded Pain Reliever

By definition, a topical medication is a medication administered externally. Commercially available topical pain relievers usually contain one or more of the following ingredients: lidocaine, menthol, methyl salicylate, capsaicin and camphor.

The Food and Drug Administration (FDA) defines drug compounding as “combining, mixing or altering ingredients to create a medication tailored to the needs of an individual patient.” It notes: “[c]ompounded drugs are not FDA-approved.” Compounded medications can be made into a variety of dosage forms (e.g., oral, injectable, topical, etc.), but the majority of compounded medications we have seen in workers’ compensation are topical (i.e., applied to your skin).

Coventry and First Scripts 2018 Drug Trend Series Report noted that topicals represent 5.1% of high-impact drug classes by volume but 14% of costs. 68 of every 1,000 workers were using topical prescription analgesics, and nearly eight of every 1,000 workers were using private label topical analgesics. As Coventry’s Director of Pharmacy Product Development Nikki Wilson noted, retail, mail-order and out-of-network prescriptions for compounds costs and use decreased while topical costs and use increased in 2018. Topical costs increased due to the use of private label topical analgesics (PLTA), some of “[w]hich add little to no value clinically but increase costs exponentially” according to Wilson.

Studies Making News

In November 2016, CVSHealth published The Rise and Fall of Compound Spend – Ongoing Monitoring Enables Early Identification of Lidocaine Spend, which noted that gross costs per compounded claim “increased nearly 1,700 percent for employer clients” from January 2011 to March 2014, while the “[a]verage gross cost per 30-day script increased more than 10-fold over a three-year period.” Leveraging a multidisciplinary team that included pharmacists and physicians, CVSHealth developed criteria to provide “coverage consistent with labeling, FDA guidance, standards of medical practice and evidence-based drug information to help ensure patient safety and appropriate utilization.” Their strategies drove the use of lidocaine products down on average by more than 80%.

In the August 2018 Office of Inspector General (OIG) report, Questionable Billing for Compounded Topical Drugs in Medicare Part D, OIG found that about 550 pharmacies and 124 prescribers had questionable Part D billing for compounded topical drugs in 2016 based on five measures that OIG has developed as indicators of possible fraud, waste and abuse. The study was driven by the 625% increase in compounded drugs from 2006 through 2015. OIG made several recommendations, including clarifying Part D coverage policies, conducting training for Part D sponsors on fraud schemes and safety concerns related to compounded topical drugs, clarifying that sponsors may apply utilization management tools, and following up with the pharmacies and prescribers identified in the report.

Workers Compensation Efforts

Several insurance companies have been monitoring and addressing compound spending across the country. The Connecticut Interlocal Risk Management Agency (CIRMA) has achieved success curtailing prescription costs and opioid use by adopting a comprehensive managed care program that combines communication, education, collaboration and data. Through nurse collaboration, prior authorizations, managing the use of compound drugs, excluding long-acting opioids, discussing best practices with prescribers, addressing claims with high morphine equivalent doses and using generic drugs over brand drugs, CIRMA significantly lowered utilization of opioids and compounds. For compound drugs, CIRMA and Coventry created a dedicated drug evaluation team that managed compound drugs and prevented processing of such medications without adjuster approval and clinical input. The effort included providing adjusters with recommendations for appropriate management of compound prescriptions, which “led to a decrease in both compound spending and utilization,” where “the percentage of compound costs dropped 42% from 4.0% in 2015 to 2.3% in 2017.” 

According to CompPharma’s 15th Annual Survey Prescription Drug Management in Workers’ Compensation, the survey of 29 state funds, insurers, TPAs and self-insureds showed that there has been a 49% reduction in compound usage among survey respondents with data for 2016 and 2017. Of the respondents who provided figures, only one had an increase in total compounds reimbursed. A number of reasons were cited for the decline in total drug costs, including a continued focus on improving clinical management programs, expanding utilization review and prior authorization, dramatic reductions in compounds, changes in prescribing patterns driven by physician awareness of opioid risk, state formularies and more structured drug alerts and alert management processes.

Effective July 1, 2018, the Texas Division of Workers Compensation revised Title 28 Texas Administrative Code, amending the definition of the closed formulary to exclude “any prescription drug created through compounding” and “required pre-authorization for all prescription drugs created through compounding.” The background section stated that reimbursements per compounded drug increased 141% from calendar year 2010 to 2015, with ingredient costs for a selected group of 10 commonly compounded drugs increasing between 82% and 1,474% from 2010 to 2014.

Chesapeake Employers’ History with Opioids

For more than a decade, Chesapeake Employers has been trying to turn the tide against the opioid epidemic. In 2009, a dedicated pain management review nursing position was established within the Health Services department to identify and monitor concerning claims. Since that time, the scope of the internal pain management program has evolved and expanded greatly. Now, in addition to a dedicated pain management nurse, Chesapeake Employers’ leverages the data analytics from its Pharmacy Benefit Manager (PBM) Express Scripts and the expertise of an in-house pharmacist, physicians and nurses to stay cutting edge in the approach to care. While there are many indicators of success, the above efforts have helped reduce the dollars spent on dispensing opioids by almost 76% over a five-year period and seen the number of injured workers receiving opioids decrease by 66%. 

Some of the most notable initiatives provide necessary resources to raise awareness for providers, the public and our employees. In 2016, Chesapeake Employers gave $750,000 to the Department of Health to be used for the state’s prescription drug monitoring program (PDMP), which allows prescribers and pharmacists to review opioid fills from all sources within the state. In 2017, Chesapeake Employers launched the STOPIOID addiction campaign via radio ads, safety kits and online safety posters to help educate Maryland about the dangers of opioid abuse and addiction. The Chesapeake Employers’ Communication Department won four awards from the Public Relations of America – Maryland Chapter, including “Best in Show” for our Let’s Work to Stop Opioid Addiction Now campaign in 2018.

See also: Access to Care, Return to Work in a Pandemic  

A final highlight was the 2019 rollout of the Opioid Overdose Response Naloxone (Narcan) training authorized by the Maryland Department of Health, which teaches employees and the public about opioids and overdose and provides materials and training to save lives. 

Chesapeake Employer’s Compound and Topical Strategy

As stated earlier, a costly effect of reduced opioid prescribing seen throughout the industry has been a proliferation of prescribing for topical and compounded pain medications. A recent analysis of Chesapeake data reveals hundreds of thousands of dollars, a larger share of annual drug expenditures, is spent on compounded or topical medications. Similar to trends seen in the industry, Chesapeake Employers’ has observed an increase in cost and use of these medications. Since 2016, pharmacy-dispensed topicals have increased from 2.8% of scripts to 4.4% and from 6.1% to 9.3% of total costs in 2019. This does not include costs for compounded medications and physician-office dispensed topical medications, which further inflate costs. 

Chesapeake Employers leverages a multi-disciplinary team approach when managing pharmacy cost and utilization. This includes the in-house pharmacist, physicians, nurses, claims and legal professionals. The goal is to facilitate rapid injured worker recovery by using cost-effective and therapeutically effective drugs and appropriate means. 

In 2011, Chesapeake Employers’ began researching and educating our claims and health services professionals on compounded medications. The research included documenting the available medical literature and outlining the circumstances under which the use and payment for a compounded medication may be considered reasonable. The research is updated periodically and peer-reviewed by an external independent medical expert.

Closed formulary states, such as Texas, Arizona and Tennessee, only cover drugs on the adopted Official Disability Guidelines (ODG) Workers’ Compensation Drug Formulary list. According to the NCCI’s June 2019 Research Brief Formulary Implementations and Initial Impacts on Workers Compensation, use of topical and compound drugs in Tennessee decreased 35% following the requirement of pre-authorization for all topicals and compound drugs, regardless of the ODG Formulary status. By contrast, Maryland is an open formulary state, which allows physicians to prescribe any medication available on the market. In an effort to address the use of costly topicals and compounds, Chesapeake Employers leverages established medical policy supported by evidence-based medicine and guidelines to help educate healthcare providers. Assessment of the topical’s therapeutic value becomes necessary in continuing its use with our injured workers. Research shared from the American Medical Association (AMA) Opioid Task Force, medical journals and the Federal Drug Administration’s Opioid Analgesic REMS Educational Blueprint shows healthcare providers are less likely to prescribe medication when educated about the risk, especially when guidance is supported by medical guidelines and continuing medical educational training focused on opioid prescribing, non-opioid alternatives and pain management. An educated prescriber provides another layer of protection to the process, because providers are asked to provide the rationale that supports medical necessity and appropriateness. 

In addition to discussions with providers, Chesapeake Employers has implemented other successful initiatives. The company partners with a local compounding pharmacy to meet the prescription needs of injured workers at a lower cost. The company also provides educational letters to prescribers for high-cost topicals for which there are therapeutically equivalent alternatives at a much lower cost. Some individual claim recommendations generate cost savings of greater than 85% without compromise of the desired clinical outcomes.


Educating patients, educating prescribers, using a multi-disciplinary team, enhancing data analysis and reporting, in addition to using peer reviews and independent medical evaluations (IMEs), offer a cohesive approach to evaluating the medical necessity and therapeutic effectiveness of compounds and topicals.

In the face of rising use and cost, insurance companies must help injured workers receive cost-effective and therapeutically effective drugs so they can receive the care they deserve and ultimately return to work and more productive lives. 

See also: Can AI Solve Health Insurance Fraud?  

However, there is still a lot of work to be done when it comes to taking care of our injured workers. It is strongly believed that healthcare professionals are conscious of prescription costs when they are educated about the cost ramifications of their prescribing habits. Greater awareness and transparency about topical pain medications results in better, informed patient care decisions. As Larry Winget said in his book “It’s Called Work for A Reason,” “Knowledge is not power. The implementation of that knowledge is power.”

When all parties involved in the workers’ compensation system understand the therapeutic equivalence, effectiveness and cost savings from using alternatives; and the importance of only prescribing drugs when it is medically necessary for the injured worker, everyone wins.

Big Changes Coming for Workers’ Comp

There is still much unknown about how deeply and pervasively the pandemic will affect the U.S. and global economies; however, a deep and long-lasting recession is now a foregone conclusion. The downstream effects of a recession will change the workers’ compensation market dramatically for years to come.  

Employers should anticipate a hardening workers’ compensation marketplace beginning soon.

Rate Increases:   

For the past decade, employers enjoyed the advantages of a soft market. Premium rates fell year over year; in 2019, the average workers’ compensation rate was at the lowest point in the 46 years since 1973 [California Workers’ Compensation Insurance Rating Bureau’s 2019 State of the System report]. 

Businesses in all industries should expect workers’ compensation rates to increase dramatically over the next few renewal cycles. Insurance carriers offering both guaranteed-cost and high-deductible policies maintained their market share in a competitive marketplace with enticingly low premiums. Carriers partially offset the cost of insurance with the burgeoning investment returns earned in the booming stock market. With stock market returns evaporated, carriers must now charge the actual full cost of the insurance plus overhead, operating costs and shareholder profits, which will result in dramatically higher premiums.

Reduced Availability of Coverage:

Over the past decade, carriers competed for the employer’s business by offering a plethora of competitive options.  

Welcome to the new reality of a hard market. In previous hard markets, carriers exited the workers’ compensation market altogether to focus on more profitable and predictable lines such as general liability, auto, directors and officers’ coverage and the like. With limited competition, the few remaining carriers will become more choosy. Even employers with long-term, loyal relationships to a carrier may be bewildered to be refused a renewal offer. New coverage pricing may be so costly as to require the employer to re-think its entire business and pricing strategy. 

This marketplace reversal presents distinct challenges to employers unable to absorb the higher cost of workers’ compensation insurance. Higher insurance rates will hammer companies that have long-term, fixed-price contracts or that operate in markets with cutthroat competitive pricing such as service-based businesses, construction and government contracting.

See also: COVID-19: Implications for Business Models  

A Safe Port in the Storm: Self-Insurance

However, all hope is not lost. A few alternatives to traditional workers’ compensation insurance have always existed. In California, there is a reliable and robust self-insurance option for employers. A recently conducted actuarial study found that self-insured employers lowered their workers’ compensation costs an average of 24% even when insurance rates are favorable. These savings are stable and likely would be even higher in the new hard market. Self-insurance is primarily available to medium-sized and large companies that meet specific financial criteria. Self-insured groups (SIGs) exist in many industries, making self-insurance accessible to smaller employers.

Self-insurance is a stable, predictable and lower-cost option to employers in boom times and recessions.

The employer pays only the direct cost to adjust the claims on an as-incurred basis. There is no carrier involved, so there is no risk of rate increases or lack of available coverage.

In any market, self-insurance offers employers four additional and significant benefits: greater control, increased savings, improved outcomes and peace-of-mind.

Greater Control: Self-insured employers can design their programs, so they exert greater control over how the program works. Employers can determine priorities based on the needs of their company and employees. Priorities may include such objectives as more robust claims processes, faster return-to-work cycles, white-glove treatment of their employees and telemedicine.

Increased Savings: Employers save money because they do not pay carrier overhead, marketing and shareholder profits, as demonstrated in head-to-head studies comparing traditional and high deductible policies with self-insurance. 

Better Outcomes: With the potential of greater control over the care and treatment of the employees and processes comes improved outcomes for injured workers. Employees of self-insured companies receive the care and treatment they need in a timely way, delivered by providers chosen by either themselves or their employers. Expedited medical treatment, caring claims administration and return-to-work programs can hasten healing and recovery of the injured workers. Greater control results in employees reclaiming their lives and returning to work sooner, equaling happier employees at a lower cost to the employer.

See also: COVID-19’s Impact on Workers’ Comp  

Peace of Mind: A stable and predictable workers’ compensation solution, together with improved outcomes all at a lower cost, contributes to peace of mind for the employer.

Are you interested in looking into self-insurance for your company? First, check with your agent or broker. Some brokers may be knowledgeable and willing to assist you in becoming self-insured, working for a flat fee instead of a commission paid by the carrier. If your agent is not able to assist you, contact the California Self-Insurer’s Security Fund or visit the website at www.securityfund.org. 

Firms’ Priorities During Pandemic

The COVID-19 pandemic is upending the way employers conduct regular business operations. Most industries now face a wide variety of challenges, including dislocation of their workforce, lost revenues, changing priorities and employee safety, to name a few.

Three industry experts joined us for our special edition Out Front Ideas COVID-19 Briefing Webinar Series to discuss the major issues facing each of their industries: 

  • Shaun Jackson – executive director of risk management, Panda Restaurant Group
  • Rich Reynolds – senior manager of workers’ compensation, Providence St. Joseph Health Shared Services
  • Steven Robles – assistant chief executive officer, Los Angeles County


Public entities face a host of different issues based on their location throughout the COVID-19 crisis. One of our guests explained the significant issues facing public entities currently:

Resource drain on risk management. Risk managers who typically handle workers’ compensation, liability, finance, safety, privacy and contracts for public entities are being outsourced to function as disaster service workers, making resources limited. Up to 60% of Los Angeles County’s risk managers are being used for disaster management.

Cyber and privacy challenges. Some employees are working remotely, but most public entities were not set up for a large portion of the workforce to shift to remote work. Currently, counties are learning how to manage security concerns associated with this shift by adding layers of privacy, like VPNs.

Workers’ compensation presumptions. The resulting costs of presumptions for first responders and other essential employees within the public entity realm could increase costs by 30% to 50%. If post-traumatic stress disorder is included in presumption laws, it could result in an additional 10% to 15% increase. Public entities are cutting back budgets to mitigate expenses, but additional costs could lead to potential layoffs.

See also: Business Continuity During COVID-19  

Employees returning to work. Public entities consist of both frontline and remote employees. Plans are being developed to phase in remote workers while still reducing possible exposure for both groups of employees. Concerns like childcare access and shielding more susceptible populations like the elderly and immuno-compromised are all being considered.


Employees in healthcare, one of the most drastically affected industries, have to adjust to the constant challenges of COVID-19. One of our guests shares the most pressing concerns facing the industry:

Personal protective equipment (PPE) shortages. The healthcare industry is enlisting other businesses and organizations to fabricate masks and ramp up production of protective gear as they face a lack of necessary protection for frontline employees caring for COVID-19 patients.

Uncertainty about the future. Without enough information about COVID-19, there are many questions to be asked. Are states reopening too quickly? Will we face a second wave of cases and deaths? Do we have the testing capabilities that allow a return to our normal daily lives?

Financial impact of elective procedures. Due to the massive influx of COVID-19 patients, elective procedures are temporarily on hold. This pause has created a financial strain on a healthcare system that relies on these procedures.

Telemedicine development. One of the positive outcomes of COVID-19 has been increased access to telemedicine. If this becomes a more cost-effective alternative, it could mean a decrease in brick-and-mortar healthcare locations and a possible change in overall business models. 


The restaurant industry is facing one of the most challenging times in its history. Still, some with overseas operations were preparing as early as December, knowing the U.S. would eventually be affected. One of our guests discussed the industry’s challenges and how they are adapting:

Reworking business continuity and crisis response programs. Due to the state-by-state and county-by-county differences in stay-at-home orders, all crisis responses had to be retooled. Most of these plans had a great framework, but, because of the variances per jurisdiction, the industry could not replicate and impose these plans. Data from the Centers for Disease Control and Prevention (CDC) and the Federal Emergency Management Agency (FEMA) have made it easier to track COVID-19 hot spots, allowing restaurants to manage location openings. 

Defining the essential workforce. Restaurant employers are working with local health officials to identify which employees within a restaurant are essential. Because employers are at the mercy of the latest emergency guidance per jurisdiction, these efforts to comply help build relationships within each market.

PR and media response. Because many jurisdictions are requiring guests to wear face masks in public, restaurants are now having to learn how to respond to those opposing these restrictions. Knowing possible confrontation with these guests could occur, employers are responding by educating employees on how best to respond in these situations. Health departments are now also publishing lists of locations where five or more employees have tested positive for COVID-19, so restaurants are now facing possible damage control if deemed an “outbreak location.” 

See also: COVID-19’s Impact on Delivery of Care  

Contact tracing. Restaurants are moving forward with their own models of contact tracing for cases of COVID-19, knowing that a government model could take time to develop. They have set up their own process of quarantining and monitoring to prevent further transmission of the virus, knowing that any outbreaks could damage their reputation. 

Change management, flexibility and risk management have exposed their critical importance in business operations throughout this pandemic. Knowing this, all organizations will need to rethink their continuity plans as they address the complexities of reopening and returning to work. Because we know businesses will never again operate under the same model, there is an ever-increasing need to think differently and to work together across multiple industries to share insights and develop the best plans for the future.  

To listen to the full Out Front Ideas with Kimberly and Mark webinar on this topic, click here.