DRI Comp Conversations: Episode 24

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Welcome back to another episode of the comp Conversations podcast,
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a podcast developed through DRI where we discuss the world
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of workers compensation, exploring issues involving occupational injuries, treatment, claims, management,
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and litigation, as well as future trends and emerging issues
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in this area of law. My name is Shane Dawson,
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a partner with Dinsmore and Scholl, and I am here
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with Jennifer White, a founding member of the Tennessee and
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Kentucky firm of Peterson White. We have the honor to
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welcome Mark Peugh to today's podcast. Mark is one of
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the founders of College. More importantly for our audience, he
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is plugged in as much as anyone I know to
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work his compensation trends nationally since he works with employers, TPAs,
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providers and vendors across jurisdictions. Mark Pew Welcome to comp Conversations.
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Thank you.
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Shane and Jennifer really appreciate the invite. And it's very
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tough to follow an FM kind of voice like that,
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so you're going to have to be stuck with my
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southern drawl.
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He does have a voice for radio's.
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Definitely and a face for radio as well. I'm one
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going to go there, all right.
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Well, Mark, thank you again for joining us, And if
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you could just tell us a little bit about the
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workcomp College and what it is and why you started it.
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Well, it started when I got laid off from my
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job at sixty years old and I decided I didn't
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want to work for someone again and start something in.
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A friend of mine opined that a lot of insurance
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carriers and work comp we're not doing the kind of
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immersive training or even comprehensive training that people used to
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get ten fifteen years ago, and said that we really
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should launch some training specifically for that to kind of
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fill that gap. And because I've been preaching the gospel
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of the biopsychosocial treatment model for about fifteen years, I said,
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let's not just teach about hard technical skills, but also
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soft skills, things like emotional intelligence and motivational interviewing and
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empathetic communication. And so the original partner, Donald Abrams, approached me.
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I brought my friend Bob Wilson in, who's been advocating
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for renaming the industry entirely from workers' compensation and workers
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recovery and actually wrote a book about that recently. And
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so we started WORKMP College in twenty twenty two and
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we've been going one hundred miles an hour since then.
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Exactly your background and career path before you started.
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Us, Well, I am a technologist by background, did about
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twenty years of software development, project management and so forth,
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and got an opportunity to develop a claims management system
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for a utilization review company in nineteen ninety nights and weekends.
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So I listened to a lot of Super Bowls on
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radio because I was working in and around my day
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job on that. And as a software developer, you can't
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build something without knowing what you're building for, and so
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I became very interested in healthcare in utilization review process.
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I'm obviously workers compensation the claims process. And then in
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twenty twenty, after guiding a choice point through Y two K,
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which actually was a legit thing, just for those of
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y'all that don't think that we made that up, but
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it was legit. And after doing that, I went full
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time into work comp and really focused kind of what
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I learned on that. In two thousand and three, I
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started to recognize the peer reviews were including a lot
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of prescription opioids and a variety of other drugs that
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didn't make sense together, and not being a clinician, just
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a logician, it didn't really make a lot of sense,
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And so I dove into it and created a product
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specifically to address, Hey, why are we prescribing all these
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opioids that the label says you shouldn't use long term
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and you definitely shouldn't be using for the kind of
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treatment that injured workers are doing, and increased the likelihood
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of having anti indepressants and anti sleep sleep aids and
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constipation aids and all that different thing. Once started, one
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drug regimen became a multi drug regimen, it was actually
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doing more harm than good to the injured worker. So
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that kind of started my the arts professor kind of moniker,
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just kind of diving in deep. I read hundreds of
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thousands of pages of medical records, looked at hundreds of
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thousands of PBM transactions, and by immersion and hanging hanging
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out with really smart people of all such sorts of
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different clinical and claims disciplines, learned on the fly and
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you know fast. For I'm in the midst of Hotel California.
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I've been in it for thirty plus years and I
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can't find the door out. And part of that is
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just because it's intellectually stimulating. Part of it's because I've
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got deep roots. Part of it is I've developed tremendous
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friendships all around the country with all sorts of different people,
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and that it's tough to shy away from that mark.
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You touched on this a little bit in your previous answer,
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but why are general healthcare trends such an important driver
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for workers' compensation claims?
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Well, healthcare costs are about sixty percent of overall total
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claims cost and work comp and so it's obviously tremendously
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important to manage that.
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And one of the things because of my evolution of.
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Arguing against the over prescribing of medications, really taking the
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easy way out and giving people pills as opposed to
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empowering them to do better. I've evolved into biopsychosocial I
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evaluated virtual reality, i evaluated medical cannabis. I've just been
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all over the board. So as we started taking pills
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away from people, they still needed something to manage their pain.
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And so I continued to evolve and take a look
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at that. And there's a lot of things that happen
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outside of COMP, and I think we're going to talk
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about those that have a direct impact on COMP. So
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you can get a very myopic understanding of what specifically
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focuses on COMP and then get surprised by something that
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happens in general healthcare or Medicare or Medicaid, or be
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a private payer concierge care or just anything like that.
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Those trends have ultimately a trickle down effect to work comp,
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and so I've always tried to have one eye ahead.
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I have talked about issues in work comp before other
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people have and raise them as issues, and so I
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have kind of a track record of identifying issues before
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other people and not just raising the issue, but also
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identifying potential solutions and just kind of social the issue
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so that we can have a better approach to it.
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So I think it's really important to understand what's happening
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in COMP, but it's also important to keep an eye
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on what's happening outside of COMP because that typically comes
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into confidentially.
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Mark.
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One of those issues I've heard you mentioned before is
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about the shortage of physicians that we're looking at in
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this country. Can you just provide some context and explain
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a little bit about that for our listeners.
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Yeah, well, just like the general population, we're all living longer,
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we're all working longer, and that has an impact on healthcare. However,
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there's tremendous burnout from physicians and clinicians if you've looked
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at it. A lot of physicians and clinicians don't have
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their independent practice anymore. They sold out to big hospitals
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and companies because they just couldn't handle the administrative overhead.
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There's a variety of different sobering statistics that AAMC says
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there may be a shortage of anywhere from thirty seven
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thousand to one hundred and twenty four thousand physicians by
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twenty thirty four. Nearly six percent of physician assistance, which
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are the typically the ones that you see in doctor's offices,
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they plan to retire within five years. There's a variety
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of estimates that there could be a nurse shortage between
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sixty four thousand and two hundred thousand nurses by twenty
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thirty which isn't as far away as you thought. And
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so we got a lot of we don't have as
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many Aukmed doctors as we need. I spoke to an
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Aucmed doc and she said that we had less than
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two thousand OCMED docs for the entire country. I spoke
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to someone recently. They said it's more like fourteen hundred.
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So there's this healthcare shortage of physicians and clinicians that
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through a variety of reasons retirement, burnout, selling out to
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larger corporations and stuff, and we're not getting enough to
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replace them.
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And so that is going to.
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Create provider deserts, especially specialty deserts where you used to say, okay,
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we got an ophtalmologist within fifty miles. Now if they
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live in a rural area, they may have to drive
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two hundred miles to the nearest optalmologist, to orthopedic or neurosurgeon.
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And guess what, that not only increases the mileage reimbursement cost,
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but it also is not good for them to sit
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in a car for two hours to drive, you know,
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when they're already having problems with their back. So these
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kind of health care shortages, especially from a rural standpoint,
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is a significant issue.
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Which of these those like specialties or those areas of
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practice are are like the most impactful ones in the
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workers comp area?
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Well, I think the ones who see that the treatment
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initially are the are the hardest ones, and so I
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think OCMED docs, which are the most legit, most logical
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ones to see an injured worker right off the bat.
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The fact that we've got fourteen hundred to cover thirty
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three hundred and whatever million people that we have in
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the country right now, that is not a great ratio.
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And certainly nurses and pas are typically the ones. When
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you go to a doctor's office, you very rarely see
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an MD or do O. You're typically seeing a PA
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or nurse practitioner. I mean in a hospital, you're seeing nurses.
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So when those become less available, you're going to have
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longer wait times. The place you go to get sick
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is actually the waiting room of doctor's office, right because
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you may be there for your own issue, but you're
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surrounded by people that are sneezing and not covering, you know,
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they're touching stuff and all that kind of thing. So
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it's a bacteria farm. And the longer that you're waiting
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for that nurse practitioner or that nurse to see you
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is going to elongate everything.
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What are some.
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Things that different professionals and the worker STOMPS system particularly lawyers,
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What can we do in response to this healthcare provider shortage?
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Well, I think the first thing that everybody should do
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is to identify by by geograph, by geography, by zip code, UH,
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where your claims happen, and whether you have all the
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physicians and specialties that you need within a reasonable distance.
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They are going to be one off. There's going to
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be an injured worker in po dunk Idaho. You know
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that nobody has any you know, treatment treater close to it,
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and you just kind of have to address that with
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telehealth or some other options. But if if you're prevalent
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in the state filed Illinois area, I would dig into
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and if you don't have some specialties or you don't
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have enough front line treats and that recruit them, figure
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out alternative ways to provide treatment, whether that's new relationships
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with network UH, whether that's making sure the doctor job
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you show them love.
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If if they're the.
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Ones that have the best outcomes on assistant basis and
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you're sending a lot of injured workers there, you don't
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want them to feel like they're being taken advantage of.
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You want to make things.
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Easier, So utilization review and peer review and pre authorizations
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are certainly ways we manage cost and manage care. But
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if you've got a doctor or clinician who reliably has
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good outcomes and consistently that delivers that, don't make it
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hard reduce the pre authorizations. In fact, remove their pre authorizations.
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In some cases they've established trusts, they've shown you that
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they're going to do a good job and focus on
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function and return to work. Don't make it hard for them,
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because that's the biggest impact to people wanting to participate
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in work comp is the administrative burdens. There's a lot
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of administrative birds in healthcare. In general work comp we say,
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we tell them to hold our beer right, we make
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it even more complicated, and every juristic for California, bless
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your hearts, really complicated to do stuff there. But there's
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other states that have similar problems. So Georgia, my home state,
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is highly litigious, and that doesn't help providers either.
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So I think.
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Recognizing where your gaps are and addressing them for the
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really good doctors, show them love and make it less
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difficult for them to participate in the system, that will
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go a long way. And then finally really lean into
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telehealth Medicare embraced telehealth during COVID because we had to
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get away from in person and then they codified it permanently.
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It was temporary, it was permanent, and now telehealth is
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a legit option. I don't think work comp is fully
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embraced telehealth. That is something where you have gaps, where
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you don't have specialties and you don't need hands on
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that telehealth would be a really good option.
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What other trends should we be looking at? Any kind
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of brought to mind.
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With the shortage of doctors. I know there's been some
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kind of pushes AI being a healthcare provider. Are you
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seeing that or is that something we should look out for?
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Well, I mean we've always had doctor Google at our disposal.
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Well I won't say always, but in the past twenty years, right,
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and so if and one of the things I've discovered
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through having friends who have gone through healthcare challenges, they
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get the portal notification of the MRI reading or the
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blood sample, and they see names and words and phrases
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they don't understand, so they put it put it into Google,
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and Google tells them they're basically going to die in
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two weeks, right, So then they go into the doctor's
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office and go, Okay, you know, I'm an expert on
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this because you know, Google and now AI certainly has
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exacerbated that and made it even more prevalent for people
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to do that self diagnosis.
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And a lot of it is good. It's very very helpful.
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I've used it on occasion for myself and for friends
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and family to help them kind of understand what they're
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dealing and what the options are, what the prognosis is,
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what good treatments are, and coming into an appointment with
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the doctor.
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Certainly being armed.
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With that is helpful, but it certainly puts the doctor
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or the nurse of the PAA at a disadvantage because
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now they're competing against not only know their educational knowledge,
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but the educational knowledge of five million doctors around the
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kind around the world who've uploaded their stuff into LLM
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SO chat GPT can give that injured worker insight.
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And oh, by the.
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Way, that injured worker may not be the one who's
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doing the research. It may be their spouse and that
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spouse or supporting our support system. They may have misaligned incentives.
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They may kind of like the fact that Bob is
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home all the day now when not working, and they've
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made the adjustment to two thirds of their regular income
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and they go, you know what, it's okay, let's not
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worry about getting back to work. We kind of like this.
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So you may have misaligned incentives and so it gets
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really really complicated when you force AI. AI is either
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the devil incarnate or angels sent from heaven, depend upon
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the situation in what you're trying to get out of.
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You mentioned Mark about this a couple people being at
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home together, So that made me think a little bit
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about kind of like is aging workforce and retirement? What
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kind of data and what kind of trends are you
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seeing in terms of an aging workforce and what's that
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mean for the workers comp world.
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Well, you know, in a perfect world, I would be
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retired right now. I do not live in a perfect
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world and didn't make all the great the greatest decisions,
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including starting a starting a business at sixty years old.
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But nineteen point five percent of adults age sixty five
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or older we're either employed or actively seeking work, which
289
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is roughly double the low point seen in the mid
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nineteen eighties. Workers fifty five and older now account for
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approximately twenty four percent of the US workforce, which is
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up from ten percent in nineteen ninety four. Workers age
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fifty five and over account for over one third of
294
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workplace fatalities.
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Which is interesting.
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And workers age forty five over our sixty percent more
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likely to have delayed to return to work greater than
298
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ninety days. So those statistics show that people are staying
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in the workforce longer, and not only they bring their
300
00:17:24.640 --> 00:17:29.079
physical and psychological cool morbidities to injuries. So a forty
301
00:17:29.119 --> 00:17:33.079
five year old probably doesn't have osteoarthritis, and so a
302
00:17:33.160 --> 00:17:37.480
mniscal tear probably is fairly easy to address. A sixty
303
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five year old who's still working probably does has i ostereoarthritis.
304
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And know, by the way, if you do an amriah
305
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of their back to understand what's going on with their
306
00:17:45.920 --> 00:17:48.720
little backstrain, you're going to find all sorts of degenerative
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stuff that is expected to be there, that is asymptomatic.
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00:17:52.039 --> 00:17:53.880
But all of a sudden they go, oh, now I've
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got to pay in the back because the amri and
310
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the radiologists told me that there's a problem there. So
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that aging workforce brings all sorts of unique dynamics, cognitive decline,
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you know, site that they don't hear as well, they
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don't see as well, their depth perception is off. They
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don't make decisions as quickly as possible. If they're on
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00:18:16.319 --> 00:18:18.759
a factory floor where things are moving one hundred miles
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an hour, you need somebody who's on their game and
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they're able to make snap decisions, the right snap decisions.
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From a safety standpoint, they may say, you know, I've
319
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been doing this for forty years. I don't really need
320
00:18:31.400 --> 00:18:33.480
to worry about looking around me when I'm driving the
321
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forklift because I kind of have a sixth sense until
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they run over somebody or impale a barrel of oil
323
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that then spills over the warehouse floor. So there's a
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lot of different things that come from an aging workforce,
325
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not only the stuff that they bring to the injury and.
326
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The recovery afterwards.
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I think it's common sense that if someone has physical coorbidities,
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that their response to treatment is not going to be
329
00:18:59.680 --> 00:19:03.319
as good good. They've had a lot of life experiences
330
00:19:03.359 --> 00:19:06.240
associated with that. Their range of motion may not get
331
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back to full range of motion on their shoulder just
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00:19:09.160 --> 00:19:11.519
because they already had kind of frozen shoulder, and then
333
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this particular repetitive injury cemented it for them. There's just
334
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so many things that comes from an aging workforce that
335
00:19:18.000 --> 00:19:20.799
we didn't have to worry about fifty years ago because
336
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people That's the reason why retirement age was sixty five is,
337
00:19:24.440 --> 00:19:29.799
you know, the typical American adult lived about seventy And
338
00:19:29.839 --> 00:19:32.920
that's why SOID security is going in solvent because we
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00:19:32.960 --> 00:19:35.000
didn't anticipate people were going to be living in their
340
00:19:35.079 --> 00:19:37.440
nineties because when it was created, we only kind of
341
00:19:37.440 --> 00:19:40.119
lived a sixty sixty five. There wasn't even a concept
342
00:19:40.119 --> 00:19:42.839
of Alzheimer's in dementia fifty years ago because nobody lived
343
00:19:42.839 --> 00:19:46.240
long enough to see that evolved as a chronic disease.
344
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So there's just all sorts of things that are happening.
345
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We're living longer, which is great everybody. I wish long live,
346
00:19:53.240 --> 00:19:59.480
long life to everybody, But that longer life experience physical
347
00:19:59.519 --> 00:20:02.839
actions and reactions and injuries and stuff. They all bring
348
00:20:02.880 --> 00:20:07.160
that to the injury and that slows down recovery. It
349
00:20:07.480 --> 00:20:10.759
impacts the treatment if you're if you're obese and not
350
00:20:11.160 --> 00:20:15.039
properly treating your diabetes, guess what that surgery is going
351
00:20:15.079 --> 00:20:18.519
to have. The infections are a little more likely to
352
00:20:18.599 --> 00:20:21.440
happen and the recovery is going to be That's why
353
00:20:21.480 --> 00:20:24.960
GLP ones are really popular now to try to, you know,
354
00:20:25.000 --> 00:20:28.279
help people lose weight before surgery, because we know, if
355
00:20:28.279 --> 00:20:32.079
you're two hundred pounds overweight, giving you a total knee replacement,
356
00:20:32.319 --> 00:20:34.279
those puppies are going to be gone in five years
357
00:20:34.359 --> 00:20:37.960
because you're overweight and your knees are doing way more
358
00:20:38.000 --> 00:20:40.319
work than they should. So all of that kind of
359
00:20:40.359 --> 00:20:44.160
contributes to the cost of claims, the duration of disability,
360
00:20:44.240 --> 00:20:47.319
how quickly we get back to work, all the different
361
00:20:47.359 --> 00:20:50.359
things we have to take into account from a psychosocial standpoint,
362
00:20:51.119 --> 00:20:53.599
just so many things that make things a lot more
363
00:20:53.599 --> 00:20:56.200
complicated from a claim when you see somebody that's a
364
00:20:56.240 --> 00:20:56.960
little bit older.
365
00:20:58.039 --> 00:21:03.960
Given all of these kind of impacts both in maybe
366
00:21:04.599 --> 00:21:07.119
the development or the causing of the claim on the
367
00:21:07.119 --> 00:21:10.400
front end and also on the recovery of the claim
368
00:21:10.440 --> 00:21:13.559
on the back end, are there maybe a couple of
369
00:21:13.720 --> 00:21:18.720
things you would say, Hey, as a defense attorney, these
370
00:21:18.720 --> 00:21:23.400
are things you need to keep in mind when that
371
00:21:23.480 --> 00:21:27.960
claim comes across your desk and it's involving some an
372
00:21:27.960 --> 00:21:31.359
older employee, an older injured worker. This is what you
373
00:21:31.480 --> 00:21:32.799
need to be looking at off.
374
00:21:32.720 --> 00:21:36.880
The bat, I think causation is probably the biggest thing
375
00:21:37.000 --> 00:21:41.960
to really unravel. So, you know, did they fall down
376
00:21:42.000 --> 00:21:46.200
the stairs and break their leg because it was if
377
00:21:46.200 --> 00:21:49.680
the stairs were wet because there weren't the safety strips
378
00:21:49.720 --> 00:21:54.400
on the steps, Or was it because they're cognitively not
379
00:21:54.519 --> 00:21:58.359
as aware and have depth perception that in the age
380
00:21:58.440 --> 00:22:00.960
actually create it, or maybe they're you know, that could
381
00:22:01.000 --> 00:22:03.359
be a part of it too, but you know, you
382
00:22:03.400 --> 00:22:05.440
know that has an issue with it, you know, the
383
00:22:05.440 --> 00:22:08.640
whole degenerative thing. I think, you know, people have made
384
00:22:08.839 --> 00:22:11.960
arguments for a long time to do an MRI very
385
00:22:12.039 --> 00:22:13.920
quickly or and X ray very quickly to kind of
386
00:22:14.000 --> 00:22:16.279
understand what's going on when you're dealing with.
387
00:22:16.240 --> 00:22:17.359
An older employee.
388
00:22:17.920 --> 00:22:20.880
That MRI is going to uncover, that CT scan is
389
00:22:20.880 --> 00:22:23.319
going to uncover all sorts of stuff that has absolutely
390
00:22:23.319 --> 00:22:25.400
nothing to do with the injury, that has a lot
391
00:22:25.440 --> 00:22:28.119
to do with the recovery. So the fact that they
392
00:22:28.119 --> 00:22:31.759
have ostio or arthritis is not a work comp compensable decision.
393
00:22:31.920 --> 00:22:33.920
That has nothing to do with the fact that they
394
00:22:34.000 --> 00:22:37.279
slipped and fell in toward their meniscus, but that astio
395
00:22:37.680 --> 00:22:40.640
arthritis is going to have tremendous impact on the type
396
00:22:40.680 --> 00:22:45.160
of treatment, the pre treatment, the surgery, the post surgical treatment,
397
00:22:45.480 --> 00:22:50.079
the expectation, the expected a return to function, maybe the
398
00:22:50.160 --> 00:22:52.880
duration of disability and return to work. The fact that
399
00:22:52.920 --> 00:22:56.599
they already had degenerative issues in their knee is going
400
00:22:56.640 --> 00:23:01.480
to impact that ability. So I think from a defense standpoint,
401
00:23:01.799 --> 00:23:06.279
you really need to understand the pathology, the compensible pathology.
402
00:23:06.640 --> 00:23:10.200
So what actually was the mechanism mechanism of injury, what
403
00:23:10.319 --> 00:23:13.559
were the circumstances around that? And these are best practices
404
00:23:13.640 --> 00:23:15.599
that both of y'all do, and I'm sure a lot
405
00:23:15.680 --> 00:23:19.680
of listeners to this podcast do already. Interview people as
406
00:23:19.720 --> 00:23:23.680
soon as you possibly can after the injury, so the recollection.
407
00:23:23.319 --> 00:23:24.000
Is very.
408
00:23:25.359 --> 00:23:28.759
Fresh and you don't have people six months later going well,
409
00:23:28.799 --> 00:23:30.480
I think he did this or I think I did that.
410
00:23:31.000 --> 00:23:34.720
You know, understand exactly the mechanism of injury, understand the
411
00:23:34.759 --> 00:23:39.079
circumstances around that, or were their safety issues? Was the
412
00:23:39.119 --> 00:23:43.359
employer the supervisor putting them in unsafe positions? You know,
413
00:23:43.519 --> 00:23:46.799
had had they had a history of not being aware
414
00:23:47.519 --> 00:23:51.640
of not being present at work. Is this the first
415
00:23:51.680 --> 00:23:53.480
time that they look like they were out of it,
416
00:23:53.680 --> 00:23:55.400
or have they looked like they've been out of for
417
00:23:55.400 --> 00:23:58.240
the last six months because they've been going through a divorce,
418
00:23:59.240 --> 00:24:04.240
or they're dog passed away after fifteen years, or money problems,
419
00:24:04.720 --> 00:24:08.359
or they have physical issues that they're dealing with. They're
420
00:24:08.440 --> 00:24:12.759
not treating their diabetes correctly, they're battling the weight issues,
421
00:24:12.880 --> 00:24:16.079
they're not eating nutritiously. They think a really good meal
422
00:24:16.200 --> 00:24:19.640
is taco bell at two am. That's not you know,
423
00:24:19.680 --> 00:24:21.759
that's not really a great way to either finish or
424
00:24:21.799 --> 00:24:25.359
start a day. Depend upon what's going on, so you know,
425
00:24:25.599 --> 00:24:29.119
is this a continuation a trend or is this new?
426
00:24:29.559 --> 00:24:31.640
And then be very very careful when you do.
427
00:24:31.599 --> 00:24:36.839
Diagnostics like MRI or CT scan and be aware that
428
00:24:37.039 --> 00:24:41.559
the osteo osteoarthritis has nothing to do with the injury,
429
00:24:41.839 --> 00:24:44.440
but has everything to do with the recovery. And so
430
00:24:44.720 --> 00:24:48.359
even though you may not want to accept the osteoarthritis
431
00:24:48.440 --> 00:24:52.400
at or degenerative other issues in the lower back as
432
00:24:52.519 --> 00:24:55.599
issues from a compensible standpoint, you need to take into
433
00:24:55.680 --> 00:24:58.839
account that that is going to impact their recovery. It's
434
00:24:58.839 --> 00:25:01.000
going to impact the two the work, it's going to
435
00:25:01.039 --> 00:25:04.000
impact the treatment plan that's decided upon. It's going to
436
00:25:04.039 --> 00:25:06.039
impact the cost of the claim. It's going to be
437
00:25:06.079 --> 00:25:08.319
more costly because it's going to take them longer because
438
00:25:08.319 --> 00:25:11.759
they're already working in a deficiency before the injury happened altogether.
439
00:25:12.440 --> 00:25:13.720
So I think just.
440
00:25:13.759 --> 00:25:17.400
Doing the basics, the one on ones that the really
441
00:25:17.400 --> 00:25:18.920
good defense attorneys already do.
442
00:25:19.559 --> 00:25:20.519
Just compound that.
443
00:25:20.599 --> 00:25:23.839
But I think the microscope really is on that aging workforce,
444
00:25:24.200 --> 00:25:26.200
because there's going to be stuff that's a part of
445
00:25:26.240 --> 00:25:31.920
that injury, illness, et cetera that is not there for
446
00:25:31.960 --> 00:25:34.440
a thirty five year old that you're going to have
447
00:25:34.480 --> 00:25:35.559
to take into account.
448
00:25:36.640 --> 00:25:39.359
Mark, you talked a little bit about jlps and weight
449
00:25:39.440 --> 00:25:43.119
loss in the instance where someone might have diabetes. I mean,
450
00:25:43.119 --> 00:25:47.759
do you see JLPS impacting workers complaims in the future
451
00:25:48.000 --> 00:25:52.720
just because of the expected use of this throughout our population.
452
00:25:53.640 --> 00:25:54.839
Oh yeah.
453
00:25:54.960 --> 00:25:57.640
There was a conversation I had probably about five or
454
00:25:57.640 --> 00:26:01.119
six years ago with someone when I slid that things
455
00:26:01.279 --> 00:26:05.720
like ozempic goby, which we all can we all can
456
00:26:05.759 --> 00:26:08.920
sing in the jingles, right because they're one of every
457
00:26:08.920 --> 00:26:12.119
three commercials now is about losing weight.
458
00:26:12.960 --> 00:26:14.000
But I had this.
459
00:26:14.079 --> 00:26:18.200
Conversations like this is this is potentially a repeat of opioids,
460
00:26:18.599 --> 00:26:22.559
not that they necessarily have negative repercussions. Although this is
461
00:26:22.599 --> 00:26:27.000
another huge human trial. The COVID vaccine was a huge
462
00:26:27.039 --> 00:26:30.680
clinical human trial with millions of people taking something that
463
00:26:30.720 --> 00:26:35.119
hadn't been fully teased out from mRNA. The same thing
464
00:26:35.240 --> 00:26:38.680
with ozempic and the gop ones. There's been clinical trials,
465
00:26:38.720 --> 00:26:41.000
but nothing like one hundred and thirty million people taking
466
00:26:41.000 --> 00:26:43.279
it and figuring out what happened. So we don't have
467
00:26:43.359 --> 00:26:47.160
longitudinal studies in regards to what the impacts are. So
468
00:26:47.240 --> 00:26:50.000
that was one thing, but the other thing. The other
469
00:26:50.039 --> 00:26:53.680
two things I mentioned at that time is that the
470
00:26:53.759 --> 00:26:56.880
statistics even back then showed that if you take one
471
00:26:56.920 --> 00:27:01.119
of these drugs, you will lose weight, but chances are
472
00:27:01.160 --> 00:27:04.160
if you stop taking the drug, you'll not only regain
473
00:27:04.279 --> 00:27:08.000
all the weight that you lost, but you'll typically historically
474
00:27:08.200 --> 00:27:12.599
gain even more back. So if you engage with golp
475
00:27:12.799 --> 00:27:17.359
ones without any kind of behavioral changes, So if you
476
00:27:17.440 --> 00:27:19.359
just go, hey, we're going to take a shot every
477
00:27:19.440 --> 00:27:21.119
day and that's going to get rid of your weight
478
00:27:21.279 --> 00:27:24.039
and that's going to be great, that's either going to
479
00:27:24.079 --> 00:27:26.920
be a lifetime expense, which is what opioids became, and
480
00:27:27.039 --> 00:27:31.559
dramatically increased reserves and reduced the ability to settle claims
481
00:27:31.880 --> 00:27:34.640
because we incorporated a drug that was not meant for
482
00:27:34.680 --> 00:27:37.240
long term use, that was used for long term just
483
00:27:37.279 --> 00:27:40.720
because it was difficult to taper for. Golp One's the
484
00:27:40.759 --> 00:27:44.799
same thing. So we're afraid that so you started it
485
00:27:44.839 --> 00:27:47.720
could be a lifetime drug. And you know, those are expensive.
486
00:27:47.799 --> 00:27:50.839
The cost have been coming down pretty rapidly over the
487
00:27:50.839 --> 00:27:53.440
past year or so, but they're still really expensive. That's
488
00:27:53.480 --> 00:27:59.000
going to balloon your reserves and your settlement strategy. If
489
00:27:59.000 --> 00:28:02.400
that is a lifetime lifestyle drug. The best way to
490
00:28:02.440 --> 00:28:05.759
do it, and I'm starting to see actually some people
491
00:28:05.799 --> 00:28:09.680
talk about this, which is good, is to incorporate behavioral
492
00:28:09.759 --> 00:28:13.480
changes along with the drug. So as you're losing weight,
493
00:28:13.759 --> 00:28:19.119
you're also eating more nutritiously, you're also better hydrated. You're
494
00:28:19.160 --> 00:28:23.720
also reducing your stress. You're also getting better sleep, you're
495
00:28:23.799 --> 00:28:28.279
also exercising. You're doing things that require no prescription from
496
00:28:28.279 --> 00:28:31.720
a doctor to do it just requires self discipline. So
497
00:28:31.920 --> 00:28:35.880
if you do golp ones for let's say, let's take,
498
00:28:35.920 --> 00:28:38.519
for example, someone is one hundred pounds overweight and they
499
00:28:38.519 --> 00:28:41.359
need a total knee replacement, it makes sense for them
500
00:28:41.400 --> 00:28:43.440
to lose as much of that one hundred pounds as
501
00:28:43.440 --> 00:28:46.440
they possibly can before the surgery, because again, if they're overweight,
502
00:28:46.519 --> 00:28:49.200
that those those metal knees are not going to last
503
00:28:49.279 --> 00:28:51.440
nearly as long as they would if you have an
504
00:28:51.480 --> 00:28:54.359
appropriate BMI. And I've had actually a friend who went
505
00:28:54.400 --> 00:28:57.480
through that and she deferred total knee replacement for six
506
00:28:57.519 --> 00:29:00.680
months while she took while she addressed her way and
507
00:29:00.720 --> 00:29:03.720
it got down to reasonable weight. So let's say you
508
00:29:03.759 --> 00:29:06.640
pay for gop ones to help them lose weight to
509
00:29:06.720 --> 00:29:10.160
get prepared for that total knee surgery, Well you also
510
00:29:10.240 --> 00:29:13.519
should be prescribing with a case manager or a behavioral
511
00:29:13.559 --> 00:29:17.920
psychologist or gym membership or something. It's like, okay, we're
512
00:29:18.000 --> 00:29:21.240
going to help you change your behavior. So because we
513
00:29:21.279 --> 00:29:24.160
don't want you taking that gop one after the surgery
514
00:29:24.200 --> 00:29:28.799
as well, we want you to maintain that proper BMI
515
00:29:29.000 --> 00:29:32.160
after you do that. So, and I know historically work
516
00:29:32.200 --> 00:29:35.720
comp hasn't paid for gym memberships, or haven't paid for nutritionists,
517
00:29:35.759 --> 00:29:38.839
or haven't paid for yoga instructors, or haven't paid for
518
00:29:38.880 --> 00:29:42.480
different things like that, But the costs for the RLI
519
00:29:42.640 --> 00:29:46.079
on that to help people become empowered and to do
520
00:29:46.160 --> 00:29:50.200
what do their part in losing and maintaining a good lifestyle,
521
00:29:50.519 --> 00:29:53.640
a good healthy weight, a good nutritional value, all that
522
00:29:53.720 --> 00:29:56.880
kind of stuff there. RLI is tremendous because if you
523
00:29:56.960 --> 00:29:59.400
don't do that, they're going to rebound and then you're
524
00:29:59.400 --> 00:30:02.640
gonna have a another total knee replacement in five years
525
00:30:02.640 --> 00:30:05.079
as opposed to twenty years because they just ground that
526
00:30:05.119 --> 00:30:08.680
puppy to bits by being one hundred pounds overweight or
527
00:30:08.680 --> 00:30:10.839
one hundred and fifty pounds because they gained one hundred
528
00:30:10.839 --> 00:30:13.640
plus to fifty's that's what the statistics show.
529
00:30:14.279 --> 00:30:15.279
And the vast.
530
00:30:14.960 --> 00:30:18.119
Majority of use of those drugs now is not on
531
00:30:18.160 --> 00:30:22.440
the diabetes. I'll know that the loss of weight was
532
00:30:22.519 --> 00:30:27.720
kind of an undattended off label repercussion, and really it
533
00:30:27.799 --> 00:30:30.240
was because we saw a bunch of movie stars all
534
00:30:30.240 --> 00:30:33.920
of a sudden, you know, go from swollen to you know,
535
00:30:34.000 --> 00:30:35.480
swollen to swollen.
536
00:30:35.559 --> 00:30:38.799
Right, and so we go, how did they do that?
537
00:30:38.839 --> 00:30:39.440
And they did that?
538
00:30:39.559 --> 00:30:42.319
So the vast and that's why they're doing advertisements on
539
00:30:42.400 --> 00:30:45.960
TV all the time. They don't necessarily are appealing to
540
00:30:46.000 --> 00:30:48.680
the diabetics. They're appealing to the people that are fifty
541
00:30:48.720 --> 00:30:52.240
pounds overweight and want to do that. So my suggestion
542
00:30:52.559 --> 00:30:56.000
and admonition from five six years ago is don't just
543
00:30:56.079 --> 00:31:00.640
prescribe this blindly. Do it in conjunction with behavioral new
544
00:31:00.920 --> 00:31:04.480
behavioral changes that you can help them not only lose
545
00:31:04.519 --> 00:31:06.359
the weight, but keep the weight off, because that's how
546
00:31:06.400 --> 00:31:08.119
they're going to live longer, that's how they're going to
547
00:31:08.160 --> 00:31:10.400
have a higher quality of life, and that's definitely going
548
00:31:10.480 --> 00:31:11.880
to reduce the cost of claims.
549
00:31:13.440 --> 00:31:16.240
Are there any other off label drug issues that can
550
00:31:16.279 --> 00:31:18.000
make their way into the worker's tromp arena?
551
00:31:19.319 --> 00:31:22.799
Well, we got shrooms now, psilocybin.
552
00:31:23.160 --> 00:31:25.799
Uh, you know, we got ecstasy, we got M D
553
00:31:26.000 --> 00:31:28.720
m A, we got all sorts of psychedelics, and people
554
00:31:28.880 --> 00:31:30.559
kind of look at that and go, Okay, that doesn't
555
00:31:30.599 --> 00:31:33.200
have any place in work comp you know, granted, we
556
00:31:33.240 --> 00:31:35.119
never would have made it to the moon if if
557
00:31:35.359 --> 00:31:37.839
people in Berkeley hadn't dropped out in the sixties, right,
558
00:31:37.880 --> 00:31:39.720
I mean, you need to kind of expand your behind.
559
00:31:40.519 --> 00:31:43.799
But there's a lot of growing evidence that psychedelics have
560
00:31:43.880 --> 00:31:49.640
a tremendous, tremendously positive impact on PTSD. The VA leaning
561
00:31:49.640 --> 00:31:53.680
into that. I spoke to a medical director several years ago,
562
00:31:54.359 --> 00:31:57.559
and she suggested she was more in favor of psilocybin
563
00:31:58.240 --> 00:32:01.359
than cannabis because psilocybin is a single molecule that makes
564
00:32:01.400 --> 00:32:05.079
it much easier to study. And so I really think
565
00:32:05.160 --> 00:32:08.640
that under medical supervision. So this is not dropping acid
566
00:32:08.680 --> 00:32:11.559
on the weekend and hoping it takes care of your PTSD.
567
00:32:11.839 --> 00:32:13.160
This is doing.
568
00:32:12.920 --> 00:32:17.319
Psychedelics under medical supervision in conjunction with behavioral kind of
569
00:32:17.359 --> 00:32:20.680
behavioral therapy and other different behavioral therapies in order to
570
00:32:20.680 --> 00:32:23.440
help work your way out of PTSD. And PTSD is
571
00:32:23.440 --> 00:32:25.640
a huge thing in work up right with the increase
572
00:32:25.640 --> 00:32:31.480
of presumptions, presumptions almost automatically include PTSD for first responders, firefighters,
573
00:32:32.160 --> 00:32:34.480
a variety of different things. If you're seven to eleven
574
00:32:34.519 --> 00:32:37.240
person and got held up at gunpoint and maybe they
575
00:32:37.240 --> 00:32:40.200
shot your coworker, you're going to have PTSD more than likely.
576
00:32:40.480 --> 00:32:43.880
And so PTSD is a huge part. And sometimes there's
577
00:32:44.559 --> 00:32:49.119
a treatment resistant treatment. You know, there are drugs that
578
00:32:49.160 --> 00:32:52.359
are used to help PTSD that not everybody responds to PTSD.
579
00:32:52.799 --> 00:32:55.880
Not everybody responds to those drugs, not everybody responds to
580
00:32:55.920 --> 00:33:00.279
behavioral So psilocybin and other psychedelics are something at is
581
00:33:00.319 --> 00:33:04.000
going to come because there's growing evidence there's growing admission
582
00:33:04.359 --> 00:33:08.279
of that. I mean think back back fifteen years about acupuncture.
583
00:33:08.599 --> 00:33:11.640
Acupuncture was like, we don't do that in the West. Well,
584
00:33:11.799 --> 00:33:14.319
now you look at New York, you look at Washington,
585
00:33:14.440 --> 00:33:20.599
you look at ODG acupuncture, medicare Va. Acupuncture is pretty
586
00:33:20.640 --> 00:33:23.480
mainstream and they're seeing a lot of evidence and they're
587
00:33:23.480 --> 00:33:27.279
seeing the science behind why acupuncture works in some circumstances.
588
00:33:27.680 --> 00:33:30.400
So I think from work comp standpoint, my mind was
589
00:33:30.480 --> 00:33:34.000
open when I said, Okay, opioids are bad, and well
590
00:33:34.039 --> 00:33:37.759
not opioids are bad. Opioids are overused, and they begat
591
00:33:37.799 --> 00:33:41.960
these crazy cocktails of other prescription drugs. What are some
592
00:33:42.119 --> 00:33:44.880
other options? And it really opened my mind to look
593
00:33:44.920 --> 00:33:49.000
at other things besides just Western medicine. So that's something
594
00:33:49.039 --> 00:33:51.880
to keep an eye on. The Other thing is cannabis.
595
00:33:51.960 --> 00:33:54.359
I became kind of the Matthew McConaughey of work comp
596
00:33:54.640 --> 00:33:58.519
back in twenty fourteen when New Mexico said that medical
597
00:33:58.559 --> 00:34:02.119
cannabis was reasonable and ness, and I warned then that
598
00:34:02.200 --> 00:34:06.119
it was going to become an issue of risk management
599
00:34:06.200 --> 00:34:10.039
because it's very difficult to its present, but it's not
600
00:34:10.079 --> 00:34:14.880
necessarily intoxicating. So just because you test positive for it
601
00:34:14.920 --> 00:34:17.880
doesn't mean that you're impaired. And that's a real challenge
602
00:34:17.920 --> 00:34:20.920
with that, and I've been warning about that for a while.
603
00:34:20.920 --> 00:34:22.679
It's like, Okay, there's a lot of payers that have
604
00:34:22.760 --> 00:34:25.320
hung their hat on Okay, it's illegal, it's Schedule one.
605
00:34:27.440 --> 00:34:29.480
We don't have to worry about it. We just say
606
00:34:29.639 --> 00:34:31.840
it's illegal, so we don't have to pay for it. Well,
607
00:34:31.920 --> 00:34:35.480
on June twenty ninth, the DEA is having a meeting
608
00:34:35.760 --> 00:34:40.360
where they are contemplating rescheduling marijuana cannabis from Schedule one
609
00:34:40.400 --> 00:34:41.639
to Schedule three.
610
00:34:41.639 --> 00:34:43.639
And not just for medicinal purposes.
611
00:34:44.119 --> 00:34:46.320
And by the time people listen to this podcast, that
612
00:34:46.440 --> 00:34:49.320
meeting may have already happened and the results might be there.
613
00:34:49.440 --> 00:34:53.119
We're recording it just prior to it. My anticipation is
614
00:34:53.159 --> 00:34:55.840
that they're going to say that every cannabis, all the
615
00:34:55.880 --> 00:34:58.360
forms of cannas, not just medical, but everything is going
616
00:34:58.400 --> 00:35:00.599
to be Scheduled three. That's going to open the up
617
00:35:00.760 --> 00:35:04.519
research from a US standpoint, We're going to really finally
618
00:35:04.599 --> 00:35:07.639
understand whether it's actually good for chronic pain or anxiety
619
00:35:07.679 --> 00:35:10.639
or sleep disorders, some different things. But the payers that
620
00:35:10.719 --> 00:35:14.000
have been hanging their hat for fifteen years that are
621
00:35:14.079 --> 00:35:16.719
ten years that it's illegal and therefore we don't have
622
00:35:16.760 --> 00:35:18.639
to worry about it. You're going to have to change
623
00:35:18.639 --> 00:35:22.239
your team. There was one payer I recall in Maine
624
00:35:22.400 --> 00:35:26.480
that the injured worker actually was taking less prescription drugs.
625
00:35:26.679 --> 00:35:29.119
It was costing them twelve hundred dollars less per month.
626
00:35:29.880 --> 00:35:33.039
He said that the cannabis was helping him in dealing
627
00:35:33.039 --> 00:35:35.960
with his chronic pain and anxiety and depression and sleep disorder.
628
00:35:36.280 --> 00:35:37.880
They could took it all the way to the main
629
00:35:37.960 --> 00:35:41.159
Supreme Court because their corporate culture is we don't like weed,
630
00:35:41.760 --> 00:35:43.519
and so they took it up to court, even though
631
00:35:43.519 --> 00:35:46.280
they were saving money and the injury worker was getting
632
00:35:46.360 --> 00:35:50.159
better treatment that was less dangerous to him. They took
633
00:35:50.280 --> 00:35:52.559
the main Supreme Court, and the Main Supreme Court said, yeah,
634
00:35:52.599 --> 00:35:54.440
it's illegal to federal level, so you don't have to.
635
00:35:54.800 --> 00:35:58.079
So it's somewhat of a pyrrhic victory. They did not
636
00:35:58.360 --> 00:36:02.840
accept savings from US dollar standpoint and better actual clinical
637
00:36:02.880 --> 00:36:05.960
outcomes for that injury worker because their corporate culture said,
638
00:36:05.960 --> 00:36:08.239
we don't do weed. Well, now they're going to have
639
00:36:08.280 --> 00:36:11.360
to revisit that if it does become Schedule three it's
640
00:36:11.400 --> 00:36:15.440
not illegal. Well, there as complicated as far as whether
641
00:36:15.440 --> 00:36:17.719
it's illegal or not. But Schedule three takes it out
642
00:36:17.760 --> 00:36:20.880
of the Schedule one, which has all sorts of so banking,
643
00:36:21.400 --> 00:36:24.280
all sorts of different things. Cannabis. There's already a big
644
00:36:24.320 --> 00:36:26.960
cannabis and that's been for the past ten years. All
645
00:36:27.000 --> 00:36:29.960
these huge companies, big tobacco, always wanted to being the
646
00:36:30.000 --> 00:36:33.840
cannabis industry. They're actively seeking because they got vaping, they
647
00:36:33.960 --> 00:36:37.079
got the perfect they already have the built in manufacturing
648
00:36:37.119 --> 00:36:40.239
of being doing that. Big pharma. Oh my god, they
649
00:36:40.639 --> 00:36:44.519
would sell their well, I won't say that. They would
650
00:36:44.679 --> 00:36:47.920
love to be in the cannabis industry. So the once
651
00:36:47.960 --> 00:36:51.199
Schedule three happens, all bets are off, and you know
652
00:36:51.519 --> 00:36:55.679
of variety. Most of jurisdictions have either legalized medical and
653
00:36:55.840 --> 00:37:00.280
or recreational. And then you've got CBD and CBG, which
654
00:37:00.320 --> 00:37:04.679
is it's very very complicated, right, So that is something
655
00:37:04.800 --> 00:37:07.840
if the meeting on June twenty ninth happens, if the
656
00:37:07.960 --> 00:37:10.880
outcome is what I expect, by the time you listen
657
00:37:10.920 --> 00:37:13.320
to this, you may be dealing with a whole different
658
00:37:13.320 --> 00:37:16.320
reality about how you interact with cannabis in your workplace
659
00:37:16.679 --> 00:37:19.920
and certainly from a treatment standpoint for injured workers.
660
00:37:20.840 --> 00:37:23.639
That's really interesting, Mark. I want to touch on one
661
00:37:23.719 --> 00:37:26.760
last thing, and you mentioned this with regards to GLP
662
00:37:26.960 --> 00:37:31.679
ones in terms of the mental health side of that
663
00:37:32.280 --> 00:37:34.679
as a wrap around with the treatment, and you touched
664
00:37:34.679 --> 00:37:39.719
on it too with PTSD in terms of treatment. But
665
00:37:40.679 --> 00:37:45.039
in terms of just generally health trends with mental health
666
00:37:45.119 --> 00:37:52.119
coverage and treatment in claims more generally, there's certainly in
667
00:37:52.719 --> 00:37:57.079
the time that I've been practicing, there's more openness and
668
00:37:57.199 --> 00:38:01.960
acceptance in terms of mental health discussing it, treating it.
669
00:38:03.280 --> 00:38:07.480
How are you seeing it trend wise? How are states
670
00:38:07.840 --> 00:38:14.559
treating mental health claims within systems for coverage purposes across
671
00:38:14.599 --> 00:38:15.199
the country.
672
00:38:16.440 --> 00:38:17.280
Well, it's interesting.
673
00:38:17.679 --> 00:38:20.039
On my journey the opioid's one of the first things
674
00:38:20.079 --> 00:38:24.360
I ran across was behavioral psychology. So I started advocating
675
00:38:24.400 --> 00:38:27.519
for COTGN of behavioral therapy in twenty eleven. When I
676
00:38:27.559 --> 00:38:30.480
did my first presentation on that, I thought I was
677
00:38:30.519 --> 00:38:33.039
gonna do so with snakes in my head because nobody
678
00:38:33.079 --> 00:38:35.880
wanted to look at me. They didn't want to admit that,
679
00:38:36.719 --> 00:38:38.599
they didn't want to open Pandora's box.
680
00:38:38.679 --> 00:38:41.119
The whole phrase was just because.
681
00:38:40.800 --> 00:38:43.360
Something happened to them and their childhood doesn't impact the
682
00:38:43.360 --> 00:38:47.480
compensibility of this claim. What we've understood is what actually
683
00:38:47.519 --> 00:38:51.159
did happen to them as a child does impact the resilience,
684
00:38:51.559 --> 00:38:56.320
does impact their response to authority, does impact their ability
685
00:38:56.360 --> 00:38:59.960
to recover and desire to recover. Their locust of control
686
00:39:00.719 --> 00:39:04.280
is external. They're expecting other people to take care of
687
00:39:04.320 --> 00:39:05.880
all their problems instead.
688
00:39:05.519 --> 00:39:07.440
Of owning what they need to do.
689
00:39:08.039 --> 00:39:10.920
And so there has been a softening of that in
690
00:39:10.960 --> 00:39:13.400
our industry and understanding that we have to take into
691
00:39:13.480 --> 00:39:15.880
account the whole person. We don't have to say the
692
00:39:15.880 --> 00:39:20.559
whole person is compensable, but ignoring the fact that they
693
00:39:20.559 --> 00:39:25.199
had adverse childhood experience, or that they have a bad
694
00:39:25.320 --> 00:39:30.039
socioeconomic circumstance around them where or they've grown up with
695
00:39:30.159 --> 00:39:33.440
a distrust of authority, and so when a physical therapist
696
00:39:33.559 --> 00:39:37.159
or a doctor tells them to do something, they immediately
697
00:39:37.199 --> 00:39:39.960
distrust it because that's how they've grown up. All of
698
00:39:40.000 --> 00:39:43.400
that has a tremendous impact on their response to care,
699
00:39:43.920 --> 00:39:48.559
response to interaction, response to communication. They're always looking for
700
00:39:48.599 --> 00:39:51.280
the negative. They are glass half empty as opposed to
701
00:39:51.360 --> 00:39:54.679
glass half full. So claims a gesture may do everything
702
00:39:54.679 --> 00:39:57.960
they can to have empathetic communication, but that injury worker
703
00:39:58.039 --> 00:40:02.599
because of how they grew up thematically distrust them. So
704
00:40:02.800 --> 00:40:05.639
that's part of it. The other part is COVID broke
705
00:40:05.679 --> 00:40:08.000
a lot of people, and I think we saw that
706
00:40:08.280 --> 00:40:11.159
in crime statistics. We saw that in the increase in
707
00:40:11.199 --> 00:40:16.079
the use of antidepressants and alcohol very early on in COVID.
708
00:40:16.920 --> 00:40:19.840
We have seen the Surgeon General three or four years
709
00:40:19.840 --> 00:40:23.519
ago talked about the epidemical loneliness. We've certainly seen that
710
00:40:23.559 --> 00:40:27.920
in social media, where people cannot interact eyeball to eyeball.
711
00:40:28.159 --> 00:40:31.760
Almost all dating is done on apps, and the algorithms
712
00:40:31.840 --> 00:40:34.800
on the apps are not necessarily meant for you to
713
00:40:34.840 --> 00:40:38.760
find a lifelong partner. They're meant for you for that
714
00:40:39.920 --> 00:40:42.239
experience to explode so you come back to the dating
715
00:40:42.280 --> 00:40:45.320
app and use it again. So all of that has
716
00:40:45.559 --> 00:40:49.559
directly and emphatically impacted our mental health. We are in
717
00:40:49.719 --> 00:40:53.679
much worse mental health shape than we in. COVID had
718
00:40:53.679 --> 00:40:56.880
a lot to do with that, and as mentioned before,
719
00:40:57.239 --> 00:41:00.880
that has a lot to do with not the compensable
720
00:41:00.920 --> 00:41:03.480
part of the work comp claim, but the response to
721
00:41:03.480 --> 00:41:06.400
the work comp claim, which has a direct impact on
722
00:41:06.519 --> 00:41:10.559
the total cost of claim, the duration of disability, obviously,
723
00:41:10.599 --> 00:41:13.599
the amount of indemnity benefits, the size of the reserve
724
00:41:13.679 --> 00:41:16.119
that you have to set, whether you can settle or not.
725
00:41:16.599 --> 00:41:19.599
So the longer this takes because we just focus on
726
00:41:19.639 --> 00:41:23.559
the biomedical and not the biopsychosocial, we're shooting ourselves in
727
00:41:23.599 --> 00:41:27.360
the foot. And so the industry has increasingly understood that
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00:41:27.400 --> 00:41:30.880
we have to take that into account, not determined as compensable,
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00:41:31.360 --> 00:41:34.039
just take it into an account and adjust our communication,
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00:41:34.639 --> 00:41:41.480
adjust our ability to interact with them. So it's not
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accepting psych as a compensable diagnosis, it's admitting that psych
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00:41:47.480 --> 00:41:52.559
has a dramatic impact on the resiliency and the recovery,
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00:41:52.599 --> 00:41:55.480
which has a direct financial impact on the total cost
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00:41:55.519 --> 00:41:58.679
of claims. So fortunately there's been a lot of progress
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00:41:58.760 --> 00:42:01.639
in Shane, you mentioned this, I mean twenty eleven. Literally,
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00:42:02.519 --> 00:42:04.880
you know, people just did not want to look me
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00:42:04.880 --> 00:42:07.000
in the eye when I mentioned conon behavioral therapy and
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00:42:07.039 --> 00:42:10.360
the fact that fear avoidance and perceived insice and a
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00:42:10.440 --> 00:42:12.840
variety of things like that had an impact of direct
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00:42:12.880 --> 00:42:15.519
impact on claims. Now we know it, and now we're
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00:42:15.559 --> 00:42:18.599
building that into claim systems. We're doing all sorts of
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00:42:18.639 --> 00:42:21.719
communication and training on that, So I think we're good.
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00:42:22.119 --> 00:42:25.079
The bad news is that with the mental health challenges
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00:42:25.119 --> 00:42:28.920
of injured workers is a different layer of the onion
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00:42:28.960 --> 00:42:30.360
that we have not been used to.
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00:42:30.320 --> 00:42:30.960
In the past.
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00:42:31.440 --> 00:42:34.480
And so whether it's PTSD or whether it's just the
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00:42:34.519 --> 00:42:37.840
fact that they got competent here they didn't have a
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00:42:37.880 --> 00:42:41.480
catastrophic injury, but they absolutely curl up into a ball
750
00:42:41.559 --> 00:42:44.079
and don't do anything and never get back to work,
751
00:42:44.280 --> 00:42:47.000
whereas someone with the same exact situation got back to
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00:42:47.039 --> 00:42:50.760
work very quickly. The difference wasn't the injury. The difference
753
00:42:50.840 --> 00:42:53.119
was what was going on inside their head and what
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00:42:53.280 --> 00:42:56.000
was going on at home that had an impact on
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00:42:56.039 --> 00:42:57.880
their resilience and ability to recover.
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00:42:58.480 --> 00:42:59.599
So I think we need.
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00:42:59.440 --> 00:43:02.800
To lean in again, not determining compensibility, just taking it
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00:43:02.800 --> 00:43:07.039
into consideration that these things are impacting their response to
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00:43:07.239 --> 00:43:10.159
our care and our communication and adjust accordingly.
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00:43:12.079 --> 00:43:14.599
Mark, You've given us a lot to think about. And
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00:43:15.320 --> 00:43:17.039
if our listeners want to contact you.
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00:43:17.119 --> 00:43:20.360
Or learn more about the programs offered at workcop College,
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00:43:20.519 --> 00:43:21.800
how can they contact you.
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00:43:22.719 --> 00:43:23.800
Well, you can go.
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00:43:24.199 --> 00:43:26.280
We were smart enough to name our company after the
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00:43:26.320 --> 00:43:29.639
website or vice versus, so it's very easy. It's Workcompcollege
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00:43:29.679 --> 00:43:32.840
dot com all one word. My email address is very
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00:43:33.440 --> 00:43:37.639
simple as well, mpew at workcopcollege dot com. And I'd
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00:43:37.679 --> 00:43:40.480
also love to connect with you on LinkedIn. I carpet
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00:43:40.519 --> 00:43:43.559
bomb the industry on a regular basis with content from
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00:43:43.599 --> 00:43:46.079
all sorts of different perspectives. So if you're not connected
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00:43:46.119 --> 00:43:49.519
with me on LinkedIn, Mark Pew. I was an early adopter,
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00:43:49.599 --> 00:43:51.679
so I didn't have to put numbers in letters after
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00:43:51.719 --> 00:43:54.880
my name. It's just simply M. A. R Kpew. But
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00:43:54.920 --> 00:43:56.360
I'd love to continue the discussion.
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00:43:58.199 --> 00:44:00.639
Well, thank you so much, Thank you Mark.
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00:44:00.719 --> 00:44:18.639
This has been awesome. Thank you. Appreciate the invite.
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H