Deitz and MacArthur suggest that employers discuss with their workers compensation carrier and agent or broker ways to better manage return to work and other issues for employees who may be prescribed narcotics. They recommend four strategies for curbing narcotics abuse in workers compensation case management:
1. Appropriate treatment: Having the injured worker treated by a provider experienced in occupational injuries early on will help the worker recover sooner, making the use of narcotics for pain relief much less likely.
2. Proactive claims management: Closely monitoring claims can help to identify the inappropriate use of narcotics early on. For example, predictive modeling helps flag cases that have the potential to escalate. Claims managers can also look for early warning signs, such as multiple pharmacy or physician use (“doctor shopping”), depression, or addictive behaviors (e.g., smoking or alcohol abuse).
3. Pharmacy benefit manager: Your pharmacy benefit manager should be flagging “outlier” prescriptions for claims managers to investigate. Questions to ask:
Is the prescription appropriate given the worker’s type of injury or course of treatment?
Does the number of recommended refills align with standard protocols?
4.Treating physician consults: If the primary treating physician lacks experience in treating occupational injuries or safely prescribing narcotics, Deitz and MacArthur recommend opening a dialogue with the physician about the treatment plan and the appropriate use of narcotics. Methods of opening such a dialogue include:
Utilizing a peer-to-peer physician review, initiated either by a pharmacy benefit manager or carrier-employed physician, such as a regional medical director
Having a nurse case manager attend the injured worker’s next visit to the treating physician
Conducting an independent medical exam of the injured worker
Narcotics abuse can translate into extended employee absence, lost productivity, and higher claims costs. Is your organization doing all it can to prevent the overuse of narcotics in the treatment of on-the-job injuries?
1 New York Times. “F.D.A. Likely to Add Limits on Painkillers.” January 25, 2013 http://www.nytimes.com/2013/01/26/health/fda-vote-on-restricting-hydrocodone-products-vicodin.html (April 29, 2013).
2 The Wall Street Journal. “Painkiller Deaths Rise Faster in Women.” July 2, 2013 http://online.wsj.com/article/SB10001424127887324436104578581623467102896.html (July 12, 2013).
3 Webster BS, Verma S, Gatchel R. Relationship between Early Opioid Prescribing for Acute Occupational Low Back Pain and Disability Duration, Medical Costs, Subsequent Surgery and Late Opioid Use. Spine, 2007;32:2127-32
4 National Council of Compensation Insurance. Issues Report Workers Compensation. 2012 https://www.ncci.com/Documents/IR_2012.pdf
5 New York Times. “The Soaring Cost of the Opioid Economy.” June 22, 2013 http://www.nytimes.com/interactive/2013/06/23/sunday-review/the-soaring-cost-of-the-opioid-economy.html?_r=2& (July 12, 2013).
This article has been produced and provided by Liberty Mutual Insurance Newsletter Liberty Directions.
“Narcotics Use in Workers Compensation Injuries.” Liberty Directions. Liberty Mutual Insurance, Fall 2013. Web. 2 Sept. 2014.
A customer intentionally disrupts a display during an argument with an employee. Two co-workers with a history of conflict get into an altercation; one accuses the other of bullying. The former spouse of an employee continues to call him at work and leaves harassing messages. What do all of these situations have in common? They are all examples of workplace violence.
According to the Occupational Safety & Health Administration, workplace violence is defined as any act or threat of physical violence, harassment, intimidation, or other threatening behavior that occurs in a work setting. Incidents, which range from threats and verbal abuse to physical assaults and even homicide, can involve employees as well as business clients, customers, and other visitors.1
Steve Deig, a technical director in Liberty Mutual’s Risk Control Services group, states, “Keeping employees, customers, and visitors safe is a priority for any business. While slips, trips, and falls or lifting injuries may be more top of mind when it comes to workplace exposures, violence is a real threat and affects businesses of all kinds.” In fact, nearly 2 million workers in the United States report being victims of workplace violence every year. Employers should understand how workplace violence can affect their companies and what they can do to minimize the risk.
Potential Employer Liability
“Any business can face liability as a result of workplace violence,” says Mark Rouillard, senior referral underwriter for general liability at Liberty Mutual. “A plaintiff’s attorney can argue that a property owner or business has a duty to patrons, visitors, and employees to provide a workplace that is free from the risks of violence. Therefore, an employer who does not take reasonable steps to prevent or control this hazard may be held liable by a jury.”
While workers compensation coverage typically protects employers against lawsuits brought by employees, there are many other areas where a company may be vulnerable. Understanding your risk can help you identify and prioritize actions needed to better safeguard your business. Consider the following examples:
• Vicarious liability: An employee violates company policy and detains a suspected shoplifter. While vigorously restraining the suspect, the employee knocks over and injures a nearby customer. The employer could be held liable for the employee’s actions and the customer’s injuries.
• Negligent hiring liability: During an at-home service call, a newly hired employee steals money and injures the customer. The employer did not perform a background check, and the employee’s record indicates several recent criminal larceny convictions. As the employer failed to exercise reasonable care in selecting the employee, others were exposed to unreasonable risk.
• Premises liability: After making a purchase, a customer is assaulted and robbed while walking to his vehicle. Several of the store’s parking lot lights are not working, and a section of the security fence is damaged. By not having adequate lighting and fencing in place, the employer did not take appropriate measures to keep its premises safe.
These are just a few examples of how a business could be liable for workplace violence incidents. Consult with your legal counsel to determine how these or other exposures apply to your business’s operation.
The Financial Implications
Any life lost as a result of workplace violence represents the highest and most devastating cost for a business, as well as for families, friends, and co-workers. No matter the type or outcome of an incident, employers can also sustain other costs related to lost productivity, safety and security upgrades, crisis communications, survivor counseling, lost sales and contracts, cleaning and renovations, increased insurance premiums, and more.
According to the National Institute for the Prevention of Workplace Violence Inc.’s 2013 Workplace Violence Fact Sheet:
• Workplace violence costs an estimated $121 billion a year nationwide.
• Nonfatal assaults result in more than 876,000 lost workdays and $16 million in lost wages.
• The average out-of-court settlement and jury duty award for this type of litigation can approach $500,000 and $3 million, respectively.
The effect on employee morale and brand reputation, while more difficult to quantify, also cannot be overlooked. While most large companies have the infrastructure and financial resources to manage the aftermath of a high-profile violent event and move forward, recovery may be much more difficult for smaller businesses. For this reason, it’s important to minimize your business’s risk.
Minimizing Your Exposure
There are several actions that employers should take to mitigate the risk of workplace violence. To minimize the chance that employees, customers, and others will be exposed to a violent incident, Deig suggests that businesses:
• Adopt a zero-tolerance policy: Make it very clear to employees that any type of violence is unacceptable and will not be tolerated. The policy should communicate that all acts and threats of violence will be taken seriously, promptly investigated, and documented. Anyone in violation of the policy is subject to disciplinary action, including termination. Consider discussing the policy as part of new hire orientation/training or incorporating it into your employee handbook or manual.
• Establish consistent hiring and termination policies: For hiring, conduct background checks, request that applicants disclose prior employment history and convictions (if legally permissible), and follow up with provided references. At the end of employment, collect keys, badges, or other items that identify the individual as an employee. Consider changing security codes, combinations, keypads, and locks. Escort the individual off the premises immediately after notice and do not allow the individual to return. Review your hiring and termination criteria with legal counsel to ensure they are appropriate.
• Make counseling services available: As a preventive measure, employee assistance programs or community counseling services can offer support to troubled employees. After a violent incident, these services can provide crisis management support and grief counseling to those affected.
• Educate and train employees about workplace violence: Train all employees, including front-line workers, supervisors, and managers, on how to recognize problematic behavior and warning signs and how to respond if they are subject to or witness workplace violence.
• Install proper security safeguards: Maintaining physical control of a property can be an effective way to prevent workplace violence. Consider video surveillance and alarm systems; locks, fences, and gates; extra lighting; and keycards or electronic entry controls. Train employees on proper use and inspect safeguards frequently to identify gaps.
• Develop an emergency response plan: The plan should detail how to respond to an emergency and cover areas such as how to report incidents, evacuation procedures, contact information for those who should be notified after an emergency, and procedures for managing the media. Establish and maintain relationships with local police and fire stations and make them aware of your plan.
Your insurance provider can offer guidance and resources on ways to help safeguard your business against workplace violence and how to respond in the event of a threat. By being prepared, you will be better able to minimize your business’s risk while also providing a safe establishment for your employees and customers.
Does your company have a workplace violence policy in place?
1. Safety and Health Topics: Workplace Violence, Occupational Safety & Health Administration. Retrieved June 17, 2014
This article has been produced and provided by Liberty Mutual Insurance Newsletter Liberty Directions.
“Preparing for Workplace Violence.” Liberty Directions. Liberty Mutual Insurance, Summer 2014. Web. 2 Sept. 2014.