Registration

Breakfast

Keynote

• Speakers:

• Victoria Burkhart, Kids' Chance

• Mark Walls, Safety National Casualty Corporation

Kids’ Chance is one of the charities supported by the CLM Foundation. We’re kicking off today’s sessions with messages from Vicki Burkhart, Executive Director of Kids’ Chance; a beneficiary of a Kids’ Chance scholarship; and Mark Walls, Vice President of Safety National and a member of the Kids’ Chance Board of Directors. They’ll share the work Kids’ Chance does to provide educational opportunities and scholarships for the children of workers seriously injured or killed on the job. We’ll also roll out the CLM Kids’ Chance Ambassador Program, which will help connect potential beneficiaries with Kids’ Chance.
 

Break

Session 1 - Opiates - Separating Fact from Fiction: Legislation, Law Enforcement, Science and Intervention

• Speakers:

• Gregory McKenna, Gallagher Bassett Services, Inc.

• William Pipkin, Austill, Lewis, Pipkin & Maddox, P.C.

• David Randolph, Midwest Occupational Health Management

• Robert Walter, Poerio & Walter, Inc.

This session will address Opioids from the standpoint of medical science, consumer fraud associated with the marketing of opiates, legislation and law enforcement, with a focus on the controversial issue of Polypharmacy from the perspectives of the medical community and the claims/legal community. The panelists will identify the events which indicate opioid issues, polypharmacy issues and will discuss best practices for effective intervention.  The panelists will explain diagnostic protocols for many of the diagnoses which underlie the prescription of narcotics by the medical community.  The panelists will discuss how to use evidence rules and motion practice, including Daubert, to counter claims and “diagnoses” based upon subjective complaints, syndromes, and unsound medical science.  You will hear about realistic objectives when confronted with opioid abuse and polypharmacy and how best to achieve those objectives through intervention. 

Session 1 - Return to Work Policies and Pitfalls

• Speakers:

• Melissa Icban, ARM, Sedgwick

• Vanessa Irvin, Hurley Rogner Miller, Cox, and Waranch P.A.

• Erin Pell, Ancel Glink

Returning claimants to work provides benefits to both employers and employees. State workers' compensation laws and federal laws may affect return to work. This session will evaluate these legal aspects, along with best practices for return to work policies and pitfalls employers may encounter.

Takeaways

• Returning workers compensation claimants to work provides numerous benefits for both employer and employee. 
• When returning workers’ compensation claimants to work, employment laws, the Americans with Disabilities Act, and union agreements must be considered. 
• Many claimants require time off work, which results in benefits that must be paid by the workers’ compensation carrier, and time off work.  Efficient return to work policies can reduce exposure in workers’ compensation claims.

Session 1 - When ADA and Workers Comp Collide: Reconciling Disability Accommodation and Workers Compensation Requirements

• Speakers:

• Rajiv Das, MD, Safeway Inc.

• Erin Dougherty Foley, Seyfarth Shaw LLP

• Carolyn C Horton, Costco Wholesale Corp

• Negar Matian, Matian Law Group

Workers’ compensation claims can easily morph into civil claims for disability discrimination under the Federal Americans with Disabilities Act (as amended -- ADA).  Our session will focus on the interplay between Workers’ Compensation Act, and the ADA, both of which impose different and often overlapping obligations on employers managing injured workers’ claims and leaves of absence.  Our session will provide practical guidance to assist employers in mitigating risk and navigating the complexities of these distinct laws both during an injured worker’s leave and during the return to work or termination process.

Session 1 - Workers Comp and Fraud Investigations: Married at the Hip

• Speakers:

• Steve Carman, Celadon Trucking

• Julie Fortune, Self Employed

• Kimberly Grassel, Amerisure Mutual Insurance Company

• James M. Poerio, Poerio & Walter, Inc.

The purpose of this session is to demonstrate that fraud investigations are no longer optional. They are essential in maintaining company profitability and economic viability. According to the NICB work comp fraud costs over 7 billion dollars yearly. With organized rings growing it is the one of fastest growing areas of fraud. Perpetrators aren't just the guy with a bad claims record but also include doctors, other medical providers etc... The question is what is your company doing to stop it? Long gone are the days of just a fast claims history search and then pay or deny. Today's cutting edge work comp programs include in depth, social media checks, medical canvasses, checks of medical billings for unbundling etc... If your company doesn't have these tool at its ready - you are badly behind the curve.

Break

Session 2 - Discussions and Trends Around Workers Compensation and Medical Marijuana

• Speakers:

• Edward Canavan, Self Employed

• Michael Sullivan, Michael Sullivan & Associates

• Ronald Thackery, Thackery Group

It’s a topic that impacts virtually all employers – how will legislation surrounding recreational and medical marijuana use impact businesses, specifically, when it comes to compensability for workers’ compensation? While there has been some activity on the federal side over the past year, marijuana remains illegal under federal law because it is listed under Schedule I in the Controlled Substances Act.  Such substances are illegal to distribute, prescribe, purchase or use outside of medical research. Today, employers must understand the laws and relevant legal decisions pertaining to marijuana in each state where their businesses operate.  This session will provide attendees with the latest legislative information related to the use of marijuana in the treatment of work-related injuries and illness and feature a practical and insightful discussion from a Colorado based employer and how the organization chose to address these issues.

Session 2 - Social Security Disability and Supplemental Security Income Benefits – What are They, How are They Different, and Why Does It Matter

• Speakers:

• Ronald Cobb Jr., Lusak & Cobb

• Lindsay Huffman, Amerisure Mutual Insurance Company

• Kathy McNulty, Alaris

• Jennifer Rizk-O'Lynnger, Nyhan, Bambrick, Kinzie & Lowry, P.C.

SSD, SSDI, and SSI are terms used daily when handling workers’ compensation claims, but they are not synonymous. We will explain the difference between each type of benefits, including how they are calculated, who is eligible, and how to apply.  We will also discuss the standards for disability, and the ways a claimant may be found disabled under the Social Security Act. Combined, the attorneys on the panel have conducted over 3,500 hearings on behalf of claimants seeking SSDI/SSI benefits before Administrative Law Judges throughout the country. Our prospective third panelist is an Administrative Law Judge, who will discuss his perspective of evaluating these claims. 

Session 2 - Strategic Utilization of Data and Other Innovative Strategies for Cost Mitigation in the Medicare Allocation

• Speakers:

• Cliff Connor, Gallagher Bassett Services, Inc.

• Tron Emptage, Optum

• Lynn Munson, AXA XL

• John Williams, Verisk

This session will examine several emerging approaches to cost reduction related to Medicare allocations.  While traditional Medicare Set Asides and methodologies continue to play a significant role in any comprehensive Medicare compliance program, there are new approaches available to significantly lower costs associated with these allocations.  By utilizing the ever-increasing amount of available data related to the claim, it is possible to accurately identify multiple opportunities for increased efficiency and savings. The session will also discuss best practices for identifying drivers in soaring pharmaceutical costs, particularly those related to long-term opioid use.  This session will focus on ways of managing these costs including; dosage reduction, physician engagement and the use of triggers for identifying areas of concern in the allocation.  Further, this session will examine the benefits and concerns related to the new “Non-Submit” approach to allocations.  These statutorily permitted allocations take advantage of universally accepted clinical and legal guidelines to project future expenses related to medical care.  And while this “Non-Submit” approach mitigates many of the complications associated with traditional workers' compensation CMS submission scenarios, the full implications of this method continue to evolve.

Takeaways

• This session will examine several emerging approaches to cost reduction related to Medicare allocations.  
• By utilizing the ever-increasing amount of available data related to the claim, it is possible to accurately identify multiple opportunities for increased efficiency and savings. 
• The session will also discuss best practices for identifying drivers in soaring pharmaceutical costs, particularly those related to long-term opioid use. 
• This session will examine the benefits and concerns related to the new “Non-Submit” approach to allocations. 

Session 2 - Tailoring Complex Pain Treatments: Strategies for Working with Providers

• Speakers:

• Melissa Dunn, Self Employed

• Steven Moskowitz, Paradigm

• Kimberly Vaughn, Amerisure Mutual Insurance Company

• Lisa Warner Hunter, State of West Virginia

Biopsychosocial issues, though often recognized, frequently are not integrated into patient care. This may result in injured workers being offered pain treatment interventions – including opioids -- that are unlikely to work. Learn effective strategies to encourage treating physicians to incorporate biopsychosocial factors into treatment, including approaches to use when a physician fails to account for them and how to offer assistance and alternatives to misguided biomedical interventions. Using case examples, the presenters will suggest ways to get these cases on the right track.

Takeaways

• Identify common psychosocial factors that cause delayed recovery
• Summarize psychosocial observations to have meaning to a provider
• Learn effective strategies to encourage treating physicians to incorporate psychosocial factors into treatment
• Understand how to account for psychosocial needs when a provider is reluctant to engage

Lunch

Session 3 - Alternative Fee Arrangements (AFA)--Path to Re-Engineer Adjuster/Defense Attorney Relations

• Speakers:

• Bruce Astrachan, Retail Business Services, an Ahold Delhaize company

• Richard Denning, Shelter Island Risk Services

• Keith Higdon, ESIS

• Douglas Rosenzweig, French & Casey, LLP

As claimants seek representation and litigation volumes grow,  insurers and large self-insureds need to find new methods, incentives, and measurements for defense counsel performance.  This session recognizes that total case payment (indemnity and total expenses) is the essential standard for performance measures.  We equally recognize that time in the settlements and payments can distort the ultimate cost.  An actuarial standard must be used.  With all this technical structure, the panel brings the practical dimension of being able to communicate with executives not schooled in the details of claims.  

Takeaways

• The grand bargain of workers’ compensation (defined benefits / no litigation) is broken.  
• Re-engineering the claim process can benefit both employee and employer. 
• The fees for defense counsel are often less than 10% of total claim payments. 

Session 3 - How Then Shall We Treat Pain? Moving Past the Opioid Paradigm

• Speakers:

• Brittany Busse, Kura MD, Inc

• Marcos Iglesias, Travelers

• Nichole Wilson, Coventry

The opioid epidemic has wreaked havoc on the nation's population and economy. At the same time, we have an unresolved problem with pain, with an estimated 116 million individuals suffering from chronic pain. Why hasn't increased availability of opioids reduced the extent of pain and pain diagnoses? What alternatives to opioids are available to manage pain? How can workers' compensation providers, payers and employers help to reduce the use of opioids and improve the treatment of pain?

Takeaways

• The efficacy of opioids in acute and chronic pain is not superior to other drug or non-drug treatments, but their side effect profile is much less favorable.  
• Other drug and non-drug treatments for pain are available and in development. 
• A biopsychosocial approach to the injured worker in pain achieves better outcomes.

Session 3 - The Graying Effect: Managing WC Claims & Exposure in an Age of a Maturing Workforce

• Speakers:

• Jacqueline Gregory, Conroy Simberg

• Joanne Houghton, Crum & Forster

• David M. O'Connor, O'Connor & Associates, LLC

• John Winkler, Selective Insurance Company of America

Advances in medicine, financial circumstances, and the tightening labor supply have made the 45 to 70 yr. old demographic a larger percentage of the workforce.  With that comes the challenge of promptly returning injured mature employees to the work, which is often complicated by educational or technical limitations, pre-existing medical conditions, and disincentives to remain actively employed.  

Session 3 - The Impact of Digital Innovation on Risk Management

• Speakers:

• James Benham, JBKnowledge

• Skip Brechtel, CCMSI

• Christopher Griffith, Safety National Casualty Corporation

• Stan Smith, Gradient AI

“InsurTech” is a term applied to the many segments of new technology that are disrupting the insurance space. Many innovations are emerging to help cut costs and increase efficiency, including telematics, wearables, blockchain, predictive analytics, chatbots and artificial intelligence. This session will illustrate how these game changers could alter risk management as we currently know it.

Break

Session 4 - Claim Investigations in the Digital Age: Moving Beyond Surveillance to Social Media and Geosocial Data

• Speakers:

• Robert Harrington, Nyhan, Bambrick, Kinzie & Lowry, P.C.

• Paula Harris, Stockwell, Harris, Woolverton and Helphrey

• Carolyn C Horton, Costco Wholesale Corp

• Michael Teti, DigiStream Investigations, Inc.

• Terri Thomas, Markel Service, Incorporated

This presentation will explore how the evolution and impact of internet technology including social media and geosocial data is changing the face of risk management investigations. In this panel discussion, you will learn what is geosocial data and how it works from a technological standpoint. We will address how it can be obtained and used to investigate and defend insurance claims. You will further learn the effective use of social media information and geosocial data relative to the preservation, authentication and admission of cyber evidence in court. Privacy expectations, if any, will be addressed in relation to legal issues in this highly dynamic area including public versus private social media pages and posts with an emphasis on evolving case law in this area.

Takeaways

• Understand what geosocial data is and how it works from a technological standpoint
• Identify the specific instances and red flags which determine when and where geosocial data can further an investigation
• Understand the legal and privacy implications of leveraging geosocial data in claims investigations
• Learn how to properly preserve, authenticate and present social media and geosocial evidence in court
• Experience difference case examples to gain knowledge as to what geosocial data has accomplished in the past

Session 4 - In the Blink of an Eye: Immediate Intervention

• Speakers:

• Lawrence Bell JD, LTM, CLU, ChFC, CFP-SME, AEP, The Unique Solution

• Ann Hawkins, WellCare Dimensions Inc

• Michael Rivas, Assurance

• Darrin Schenck, TriageNow

As many efforts as payors make to prevent workplace incidents, accidents happen and often in a blink of an eye. What if injured workers could be get the attention they need and the care their injury required just as fast? Leveraging telehealth technology has taken 24/7 nurse triage to the next level – delivering truly immediate intervention. With the option of telehealth, industry payors can further compress claims timelines during that crucial first 24 hours after an injury occurs. Supplementing early claims intake, telehealth enables workers with musculoskeletal injuries (which make up the majority of workers’ compensation injuries) to be connected to providers instantaneously via a computer, tablet or phone, facilitating an expedited prescription and/or referral to an in-network physical therapist if needed. Telehealth visits cost 30% less than brick and mortar doctor’s office visits, according to some state fee schedules, in addition to having the ability to replace ER visits resulting in significant cost savings. On-demand, secure and cost efficient, telehealth offers significant benefits to both employers and employees, and is one of the critical components of immediate intervention which can upgrade your entire claims program.

Session 4 - Sexual Harassment in 2018: How to Address the Court of Public Opinion and How to Prevent Sexual Misconduct in the Work Place

• Speakers:

• Edward Canavan, Self Employed

• Erin Dougherty Foley, Seyfarth Shaw LLP

• Angel Guerra-Chagolla BA,MA, SIP, WCCA, Beauty & Beast in Business LLC

• Negar Matian, Matian Law Group

In the last three months of 2017, there were over 100 news reports of sexual harassment allegations involving public figures and senior corporate executives.  This, in addition to the #MeToo campaign, has propelled the topic of workplace harassment in daily conversations and has questioned our traditional definition of harassment at work. In this presentation, we not only discuss how the current culture has forever changed and redefined our expectations and standards for sexual harassment, but also what every business needs to know to provide a safe environment for all employees. 

Session 4 - The Evolution of Workers Compensation Claims - From Processing Claims to Fully Investigating

• Speakers:

• Steve Carman, Celadon Trucking

• Brenna Hampton, Hanna, Brophy, MacLean, McAleer & Jensen

• Jennifer Meyer, Downey & Lenkov LLC

We will focus on the transition of worker's compensation claims over the years from simply processing a reported claim to now fully investigating. This will include: early claims investigation of reported claims, identification of red flags for possible work comp claims fraud, and overview of current investigative tools and how best to use them in concert with defense counsel. A portion of the presentation will include avoiding bad faith during investigations and not running afoul of the laws in the jurisdictions. A focus of the presentation will be that you are not fully investigating each and every work comp claim – you are way behind the curve as way too many companies are still pay first instead of thoroughly investigating their claims. Some really good investigative tools include: Surveillance – the dos and don’ts and how to maximize it; Background checks – all vendors and products are not the same; Social media checks – goldmine of information; Medical canvass – the most under-utilized tool in investigations; Government records – endless potential; Loss scene canvass - you don’t know what you are missing until you check.

Break

Session 5 - From Lump Sum to Surrogate Mom: Round the Clock Medical and Financial Security for the Injured Worker

• Speakers:

• David Hickey, Brant Hickey & Associates, Inc.

• Porter Leslie, Ametros Financial Corporation

• Melanie Schafer, Gordon Rees Scully Mansukhani

This panel seeks to explain the evolution of the more serious and permanent injury cases.  From the formation of Medicare Set-Asides to post settlement services the injured American worker is best cared for now than ever.  But there are both opportunities and pitfalls for both insurers (defendants) as well as claimants.  Our experts will demonstrate the techniques and services technology, underwriting and law changes have produced; as well as what likely is on the way in our future.  Claim professionals and attorneys will benefit from understanding the options now available that affect each part of the serious accident claim.

Takeaways

• Aggressive Cost Mitigation— It’s important that any and all legal and medical arguments available are used to reduce the cost of the MSA.
• Avoid Stumbling Blocks— Stumbling blocks in the approval process cost time, money and create unanticipated medical exposures.  
• Timing is Everything— Keep in mind during the submittal process that “timing is everything” when it comes to obtaining the quickest CMS approval. 

Session 5 - Navigating Mild Traumatic Brain Injury Cases in the Workers Compensation Environment

• Speakers:

• Arthur Itkin, Leading Neurologic Opinion

• Rich Lenkov, Downey & Lenkov LLC

• Alexander Obolsky, Health and Law Resource, Incl

Complicated structural processes hamper effective treatment and management of mild Traumatic Brain Injury (mTBI) and Post Concussional Syndrome (PCS) cases.  These structural processes are entrenched and ubiquitous.  This presentation will focus on case management strategies to identify non-physiological consequences of head injury from successfully masquerading as authentic and compensable consequences of head injury.
 
Furthermore, this presentation will focus on illuminating the fundamental aspects of mTBI and PCS.  These fundamental components form the basis for data gathering when identifying individuals with mTBI and PCS.  It is postulated that effective and comprehensive data gathering leads to effective case management. This presentation will address the above-identified issues from various points of view, including clinical, legal, and case management.

Session 5 - Premium--It's Not Just About Price!

• Speakers:

• Tricia Bellich, Lewis Brisbois Bisgaard & Smith, LLP

• Mary Miller, ArlingtonRoe

Premium—it’s not just about price! A discussion of the many factors that contribute to the final premium paid by an employer. These factors include class codes, payroll, experience modification and the big swings in state filed rates. Other points that will covered are the marketplace going from a soft market to a hard market and back again in the past 5 years. Also, how the classification of workers has become muddy due to the “gig economy” as well as employers that misclassify employees to commit the big dollar fraud in the insurance industry. 

Session 5 - Workers Compensation Issues to Watch in 2018

• Speakers:

• Kimberly George, Sedgwick

• Mark Walls, Safety National Casualty Corporation

This session will discuss the latest workers’ compensation trends, concerns and emerging issues that you should be paying attention to in 2018.
 
Topics for discussion will include:
•         The influx of natural disasters and their impact on the industry.
•         The unspoken significant impact of mental health in workers’ compensation.
•         Evolving trends in pain management and opioid alternatives.
•         The ever-changing cyber risk environment.
•         Workers’ compensation fraud – perceptions vs. reality.
•         Technology, telemedicine and digital health.
•         Constitutional challenges that should be on your radar.

Cocktail Reception