Businesses face many risks related to technology, including the risk of a cyber breach resulting in the loss of protected health information (PHI), personally identifiable information (PII) or payment card information. The threats are real, and the potential losses can be steep. The Ponemon Institute found in its 2017 Cost of a Data Breach report, that the average cost of a data breach in the United States in which customer privacy was compromised was about $7.35 million, or $225 per lost or stolen record.
Organizations may also incur losses through phishing (malicious email disguised as coming from a colleague, customer or financial institution to gain access to assets); ransomware (an attack that encrypts valuable information to extort funds from the victim in exchange for the data’s release); or a denial of service attack (an attack that cripples an organization’s online operations, preventing it from doing business). These scenarios were illustrated by the WannaCry and NotPetya global ransomware campaigns and the Mirai botnet DDoS attack that disrupted internet and e-commerce services in both the United States and Europe.
The WannaCry and NotPetya attacks were the broadest and most damaging cyberattacks in history. Like most ransomware, WannaCry encrypts a victim’s digital files until the victim pays for a key to unlock the files. Hackers often demand bitcoin payments of a few hundred dollars for personal files or thousands of dollars for business files. NotPetya was spread via the compromised software update service from a distributor of tax accounting software mandated by the Ukrainian government. Once NotPetya infects a system, it sets up encryption routines and attempts to spread over the network.
The Mirai attack was notable not only for its size and impact but also for the implications. Mirai hijacked the communications of hundreds of thousands of Internet-connected devices to carry out its attack. According to some estimates, there will be more than 20 billion such internets of things (IoT) devices in service by 2020. That is a significant increase in the number of connected devices currently in use, meaning there is a corresponding increase in the risk that security vulnerabilities will be exploited for similar attacks in the future.
Whether the result of a malicious attack, technical malfunction or human error, a data breach can trigger costs related to legal, technical response and forensics, crisis management, credit monitoring, and associated services. Financial losses can also be associated with a technical failure, or fines levied by regulators. In order to help mitigate the risk, cyber insurance can provide financial protection for out-of-pocket expenses arising from a data breach. A select group of carriers has also started to offer coverage for customer flight related to loss of brand trust.
Astute business leaders appreciate that cyber risk can be managed by coupling technology with risk transfer that protects the company and unlocks growth. A select few insurance carriers have also evolved their cyber insurance forms in order to provide coverage for losses that cause bodily injury and property damage that may have been caused by a breach of the network and/or system.
Cybersecurity should be managed as both a technical and economic challenge. It should also be viewed as an opportunity to improve performance and optimize capital efficiency—not just as a cost that needs to be managed. A quantitative analysis can enable companies to more efficiently allocate capital and other resources to reduce and manage cyber risks. In order to fill the gaps and provide financial relief from a data breach, companies are increasingly turning to insurance, especially as increasing competition among underwriters has driven prices surprisingly low, while the breadth of coverage being offered has expanded.
Cyber insurance premiums, which totaled an estimated $3 billion in 2016, are on pace to reach $20 billion by 2020, with more than 60 underwriters offering policies in a competitive marketplace with no standard forms, definitions, exclusions or conditions to follow when underwriting a cyber policy. These costs are in addition to the more than $80 billion a year that Gartner says businesses worldwide spend on technologies intended to protect both data and the systems where data are stored and managed.
The tumult of operating in a new market amid so many unknowns and variables means businesses should work with a cyber insurance expert who can accurately identify and inventory key assets, data, systems, and infrastructure essential to the business’s operations, quantify a business’ internal controls, and create a digital profile to identify internal vulnerabilities and external threats. Perhaps most critical is to work with a cyber insurance expert on quantifying a value of cyber assets at risk using modeling and technology tools.
Data protection is not easy and it is made even more difficult when investments in IT security are misallocated. Because technology and the threats posed by hackers evolve quickly, it is imperative organizations take the time to better understand their risk and to examine their networks for security vulnerabilities. Whatever an organization spends on technology, cyber risk management starts with a highly-trained and aware workforce. It is imperative to have a security-focused culture, reinforced through continuous training and positive reinforcement.
Itzik Kotler, co-founder, and CTO of SafeBreach said that there are a number of emerging trends that may introduce previously unknown risks and how keeping pace with these innovations is imperative to minimizing cyber risk. For example, Kotler recalled his own conversation with the chief information security officer (CISO) of a media entertainment company in the process of constructing a new office building that included features like smart lighting, smart blinds and other IoT-enabled devices connected to the corporate network.
Kotler said the CISO expressed concern about connected devices being compromised by a hacker. He was worried about the risks if the smart HVAC devices became an infection point, or worse, were used as a malicious cyberweapon. What if, for example, their data center servers were brought down because the air conditioning was no longer cooling the facilities?
According to the Ponemon study, 24% of breaches were due to human error. Despite the billions of dollars spent on technology, people make mistakes, cut corners, become reckless and are sometimes simply unaware that their behavior is outside the bounds of company policy.
In an age when doing business requires moving data from point-to-point, and every step of that process increases the level of risk for a data breach, there is little room for complacency. That is why it is imperative companies establish and enforce policies that teach their employees proper handling of data and for the introduction of new technologies—including hardware, applications, mobile devices and cloud-based services—into the enterprise.
From a technology standpoint, it is important to recognize that no business—big or small—is fully protected from a possible data breach. For organizations considering the addition of a cyber insurance policy to their risk management portfolio, the message is clear: Adding cyber coverage as a hedge against the financial costs associated with a data breach is an effective way of transferring that risk.
When it comes to record management and customer notifications, the legal requirements for businesses are vastly different from state-to-state. Take for example California, where businesses are required by law to immediately notify a state resident if his or her personal information has been acquired by an unauthorized user. Most states have similar laws. In Alabama, however, there is no state law requiring a business to notify customers of a data breach.
But only doing the bare minimum of what is legally required can still leave your business vulnerable to reputational harm, loss of customers and disruption of business processes that may prove catastrophic in the long run. Ask yourself this: If it were your data stolen, would you want or even expect to be notified?
What Constitutes a Customer or Employee Record?
In 2016, more than 4,000 data breaches exposed over four billion records. But what exactly are we talking about when we are referring to “records” that have been exposed?
In general, data collected on customers and employees falls into three basic categories:
- Health Information such as records from a doctor’s office or human resources department
- Banking Information such as credit card, debit card or bank account numbers
- Personally identifiable information (PII) or data that can identify the person, the person’s location or other private information
It is often this last category, PII, that causes the most confusion. The federal government and many states have taken a stab at clarifying what constitutes PII and these definitions vary wildly.
Take a moment and think about the information you require from your customers or employees, or even think about the type of information you provide as a customer yourself. Everything from your password, answers to your security questions, your shipping address or even your driver’s license number is an identifying piece of information.
With just an email address and answers to common security questions, a cybercriminal can reset a password to a customer’s email account and gain access to their inbox, which can lead them to social media profiles or Netflix or iTunes accounts that house credit card or bank account information. But that’s not all. Just because your business was not directly impacted by the breach itself, your business may still be held liable for those stolen records, even if the records were stolen from a vendor.
While each state might have differences of opinion regarding which specific pieces of data you collect are legally protected, will your customers feel the same?
What Are the Risks Associated with Your Business Records?
There are two major risks when a business gathers and stores customer and employee information.
The first is to your customers and employees. Not only can there be a risk of financial harm if the right information gets into the wrong hands but an individual’s privacy and security can also be exposed. As a business, it is your responsibility to know what information you have and to notify your customers and employees—whether or not you are legally required to so by your state—if you have been breached. This is expensive and has to be done immediately and done right.
The second risk is to the reputation of your company after a breach. How you handle the moments after a breach can impact how your customers or employees react once they find out their personal and sensitive information may have been exposed. Having the right type of support after a breach can make or break a business.
What Actions Should Companies Take?
Having a clear understanding of what type of personal and sensitive information you have stored on your business’ computer system and other electronic devices is a must. The same is true for vendors that may house customer or employee data on your behalf. Maintaining an inventory of the information you have on-hand is important, especially if your business has been a victim of a breach so that you can accurately notify your customers or employees of the information that has been exposed.
To properly protect a business today you need a robust cyber insurance policy, not just any cyber policy. Any cyber policy might have customer notification costs included in your policy but a good cyber insurance policy will:
- Provide notifications for all your customers even if you are not legally required to do so as well
- Pay to maintain your great reputation in the marketplace should a breach occur
- Include forensics to determine how this happened in the first place and fix it
Another important part of coverage when choosing a cyber policy is business disruption coverage. Many businesses never fully recover from the lost business following a breach. Be sure this coverage is included in your policy. According to a 2016 study conducted by Keeper Security and Ponemon, businesses that have been victim of a breach have lost an average of $955,429 due to the disruption of normal business operations, in addition to the average cost of $879,582 companies have spent due to damages (i.e., impact of business reputation or loss of trust from stakeholders) or theft of IT assets after a breach. Can your business sustain that loss without the insurance to cover it?
By having a clear understanding of what type of records you are collecting and storing from your employees and customers, along with a good cyber policy, every business owner can rest assured that if they are a victim of a cyber attack, they have the know-how and support of their insurance provider to keep their business running smoothly with the least amount of damage to business processes and reputation.
Newer developments like a 3-D laser and sensor technologies are enabling contractors to build in a smarter and safer way. Insurers should understand where the construction industry is headed in terms of technology use and how emerging devices can help improve both physical construction sites and worker safety.
Imagine being in the middle of a large-scale office tower build, with the framing, exterior walls and roof all finished when you notice the structure’s support beam measurements appear to be wrong. Instead of going back to the architect and engineers involved in the project to confirm measurements by hand, and potentially stalling the build of the project, you use a 3-D laser scanner that in a matter of moments confirms the design measurements are on point and you won’t have to delay the build.
This is just one scenario that captures the challenges contractors face today and how the construction site of the future, which will focus on harnessing data and technology together, can ultimately help contractors build in a smarter and safer way.
For construction companies working off an architect and engineering professional’s plans, measurements could be incorrect. When transforming a warehouse into a restaurant, for example, accuracy is highly important. Moving gas and water lines and electrical, and designing a kitchen out of an open space by hand leave potential opportunity for error, which could also cost the contractor time and money. If a measurement is off by even 10 inches, this apparently small mistake could potentially lead to great costs in rebuilding. In fact, according to the American Society of Civil Engineers (ASCE), the direct costs from rework can often account for 5% of the total construction costs, which is not always insurable.
3-D laser technology captures a construction site’s lines by creating an accurate, to-scale model of the different points of the scale, including space, air, and objects. This technology measures the site down to the millimeter.
Laser technology not only provides fast, accurate measurements but also can confirm whether the measurements are in fact correct. The technology matches the architect’s design against the physical building, providing an overlay of the measurements and highlighting areas where they do not align.
Contractors seeking to build with speed and accuracy use this technology to help identify problems in real time, revolutionizing how construction companies are approaching a build. According to a report from MarketsandMarketsTM, the 3-D scanning technology market is forecasted to grow at a significant rate for the architecture and construction industry industries between now and 2023.
Future applications of 3-D technology largely fall into two categories:
Using a 3-D laser scanner on a drone: Imagine being able to have a drone scale an 80-story building in minutes while confirming measurements and accuracy from the sky. A daunting and high-risk scenario becomes a relatively easy and much safer task.
Virtual reality and augmented reality: Contractors can scan the physical building against the design, creating either a virtual reality hollow so that workers can see where pipes will go or augmented reality visuals where architects, engineers, inspectors and even homeowners can see progress on a building in real-time. 3-D scans can be overlaid against the Building Information Modeling design to provide a real-time comparison of the current build against the original design
Protecting the physical site
Among the new technologies that are currently available, mobile sensors – the size of a paperback book – can be deployed on construction sites to help detect the building’s temperature, humidity, dust particles, noise, vibrations, among other things. By monitoring the building’s environment, contractors can receive real-time alerts when the building reaches certain thresholds.
By way of example, let’s say the temperature drops in an office tower construction site. With mobile sensors, the contractor can immediately receive an alert giving them an opportunity to check on the tower. Something as simple as a pipe bursting in the middle of winter because a door was left open can lead to significant losses.
As sensor technology advances and the market becomes more competitive, we will likely see more robust sensors on the market that are able to monitor the building’s holistic environment.
Wearable sensors are another example of emerging technology – similar to the popular bracelets that track one’s physical activity or a pedometer that measures the steps someone has taken in a day – sensors are now being tailored for construction site workers to provide real-time data with the goal of increasing workplace safety.
Construction sites are a high-risk work environment. In fact, some of the most common injuries experienced on construction sites include strains and sprains, falls from elevation, and those related to heat stress. Repetitive motion injuries such as bending or lifting are also common.
Most insurance carriers today offer risk management consultants who can go onsite and provide construction clients with a snapshot of potential risks, observations, and insights into indicators that can potentially lead to workplace injuries. Wearable devices are essentially a safety professional standing behind each worker all day, every day, monitoring whether workers are bending correctly or if the site’s temperature is placing them in a heat stress environment. The technology could also connect to claims data so insurers can provide insureds with proactive proposals and solutions to help change workers’ behavior to reduce the potential for injuries.
In the future, wearable technologies will be able to harness forensic data and other information from the physical construction site as well as historical claims, while also receiving real-time data that can provide predictive analytics.
Smart sites of tomorrow
Construction sites and the construction industry as a whole represent a prime case for technology disruption. In the next 5-10 years, it is probable that all of these technologies will be capable of connecting and talking to each other while outputting data into a single monitoring system that can be used by construction companies, insurers as well as architects and engineers to help take proactive actions.
A 2016 report from McKinsey & Company found that large construction projects typically take 20% longer to finish than scheduled and are up to 80% over budget. But thanks to the construction site of the future, using 3-D lasers, mobile sensors, and wearable technology could ultimately help provide a safer, more efficient workplace and, in turn, reduce costs.
If the industry develops a solution for construction sites, it can be applied to other industries such as manufacturing, logistics, warehousing or healthcare. As economies of scale also take hold, we could see the cost of these technologies decrease and the barriers to embracing these technologies start to dissipate.
The United States is no stranger to acts of terrorism. In recent years, domestic and international events have increased with alarming frequency. More importantly, such events have shown that no area of life is completely risk-free.
Domestically, notable acts of terrorism have occurred on school campuses like Virginia Tech or Sandy Hook Elementary School. Just this month, Las Vegas experienced the deadliest mass shooting in modern U.S. history.
Concern over terrorism risk is clear and definite, but information and understanding of terrorism risk insurance is not as well known. Not-for-profit organization RIMS tackles this subject in its latest report, Terrorism Insurance: Understanding the Boundaries of Coverage for a Risk Without Borders.
Guidance for risk managers
The report provides corporate risk managers, insurance brokers and coverage counsel with guidance on determining whether terrorism risk insurance coverage is necessary, identifying terrorism risk solutions that exist in the market and insights on negotiating for terrorism coverage.
“With terrorism risk being an unfortunate reality, corporate risk managers and counsel can take proactive measures to contain a risk that otherwise knows no bounds,” said the author of the report, Micah Skidmore of Haynes and Boone LLP.
Is terrorism risk insurance coverage necessary?
Terrorism risk can be quantified and, to some extent, understood by its relationship to a variety of constantly evolving factors. Historically, domestic terrorism represented a disproportionate risk to property, relative to bodily harm, spread over numerous smaller incidents.
Most attacks occur on a seasonal basis, especially during the spring and summer months. The report also notes there is a greater likelihood of terrorist attacks in the Northeastern region of the U.S. and the coastal states like California and Texas.
Although property damage and bodily injury are the primary risks associated with terrorism, there are other dimensions companies should consider if they’re looking to minimize their exposure, such as:
- Fiduciary liability for corporate directors and officers,
- Pollution loss and liability,
- Professional (E&O) liability,
- Employment practices liability,
- Business interruption loss, and
- Privacy and network security liability.
Even when a company does not independently recognize terrorism risk sufficient to justify an insurance solution, some form of terrorism coverage may nonetheless be required by contract — including lending agreements.
What insurance solutions are available to address terrorism risk?
What terrorism insurance solutions are available to corporate risk managers? A significant market capacity exists for domestic terrorism coverage in two different forms: traditional first- and third-party policies, and so-called stand-alone terrorism risk insurance. Traditional policies, including commercial general liability and property policies, may provide some coverage for terrorism risk if not expressly excluded.
Workers’ compensation insurance — a state-regulated line of coverage compulsory in nearly every state — is another traditional policy that may provide some form of terrorism coverage. Unlike other property & casualty policies, workers’ compensation policies do not have terrorism (or war) exclusions.
To the extent that terrorism risk is excluded or unavailable under traditional policies, a corporate policyholder may consider purchasing stand-alone terrorism insurance. Stand-alone terrorism policies, however, provide a wide a variety of terms — some offering broad coverage, others very little.
They also typically exclude political risks, including loss resulting from strikes, riots, civil commotion, rebellion, revolution, war and insurrection. Cyber-related loss and liability, as well as nuclear, biological, chemical and radiological hazards such as anthrax, are also commonly excluded.
What should corporate policyholders look for in placing stand-alone terrorism coverage?
If a stand-alone terrorism policy is the preferred method of addressing terrorism risk, selecting the policy with the best terms involves more than just ensuring that coverage extends beyond “certified acts of terrorism.” Brokers and policyholders should carefully review the valuation terms in stand-alone terrorism policies to ensure that such terms appropriately compensate the insureds for loss and damage, even when actual repair or replacement may not be possible or optimal.
In a large-scale terrorism event, disputes have developed and may continue to arise over what qualifies as a separate “occurrence,” justifying either the application of separate limits or the accrual of a separate deductible or retention. To avoid such controversy and afford a measure of certainty to policyholders and insurers alike, some considerations should be given to including specific terms defining what constitutes an “occurrence” and how the number of occurrences associated with a given claim will be determined.
What other policy terms justify special consideration in a terrorism risk insurance policy?
- Expediting expense: The costs incurred to sustain operations or expedite repairs in the wake of a terrorism incident may vary substantially from any other casualty loss. Expansion of insuring terms beyond “reasonable and necessary” costs to include items such as security or healthcare-related expense may be appropriate.
- Increased cost of construction: A terrorism incident may itself prompt legislative or other practical requirements that have the effect of increasing the cost of demolition and compliant repair.
- Pollution exclusion: The “act of terrorism” may, directly or indirectly, prompt a release of hazardous substances, which increases the cost of the claim. Policies should not exclude the cost associated with a release of “pollutants” that is an indirect result of an otherwise covered “act of terrorism.”
- Sue and labor: What is reasonable to protect, recover or save insured property after a general casualty loss may be very different from what is appropriate following as an act of terrorism. To avoid disputes, language in “sue and labor” provisions should be tailored accordingly.
Terrorism risk insurance, whether through traditional or stand-alone policies, is an increasingly important element of domestic corporate insurance programs. To that end, risk managers, agents, brokers and corporate counsel should review corporate exposure to risk, existing policies and contracts to determine whether terrorism risk insurance is necessary to protect the business or fulfill contractual obligations.
Although environmental consulting has been around since the early 1970s, it’s still an expanding field with unique risks and exposures.
Governmental regulations, along with public interest in conservation and sustainability, have driven the growth of this $16 billion industry providing environmental services to virtually every sector of the U.S. economy, from surveyors conducting site assessments to engineers developing remediation plans to contractors performing cleanup and pollution abatement.
At the same time, these tasks lead environmental consultants to encounter risks that are excluded under standard commercial package policies. Pollution liability can occur when faulty work is the direct cause of environmental contamination, and professional liability arises when technical errors contribute to an incident and subsequent economic losses for a client.
Even individuals who never set foot on a job site must consider their potential exposure: lab technicians analyzing soil samples for pollutants or engineers advising on regulatory compliance plans may find themselves subject to a claim. Simply put, if your operations can contribute to an environmental incident, you are exposed.
Start with documentation
Complete, consistent documentation is the basis for an effective environmental risk management strategy. This begins with preparing detailed proposals for each project, clearly defining the work to be completed, terms of successful performance, and a realistic estimate of associated costs.
Consultants should take the time to ensure that clients understand the proposed work and agree that it addresses their concerns, so as to avoid future disputes.
Recording the obligations of consultants and clients in a formal contract reduces the potential for conflict over a difference in unstated expectations. The goal of the contract should be an equitable distribution of risk for both parties.
Identify the standard of care to be applied and the limits of liability for the consultant; ideally, this will be an amount equal to the fees charged for the project. Risk professionals should be cautious about commitments exceeding industry standards and especially wary of broad indemnification language that would expose consultants to risks unrelated to the work that they have agreed to perform.
Specify the process for addressing unforeseen circumstances, such as the discovery of unanticipated hazardous materials or subsurface structures, and employ alternative dispute resolution methods in the event of an intractable disagreement. As the project gets underway, procurement should be conducted according to established procedures and criteria.
Subcontractors present additional risk
Any project relying on subcontractors opens itself to additional risk, as the same concerns that apply to the environmental consultant extend to this group as well.
Regardless of past success with a particular subcontractor, consultants must make sure that their partners possess the relevant skills and resources to conduct and supervise the work at hand. Best practices involve prequalifying subcontractors according to expertise, resources, and financial stability, including adequacy of insurance.
Subcontractor questionnaires or other evaluations can be kept on file and updated for future projects as needed.
Project work should follow the specified scope as close as possible, with quality control checks to monitor adherence to guidelines. Team members performing the work should be qualified to conduct initial quality assessments, with senior consultants reviewing calculations and results for sensitive tasks.
If work involves the risk of physical exposure to hazardous materials, site-specific plans are necessary to guarantee conformance to OSHA standards, at a minimum. Firms should have plans in place for handling and storing waste materials and other potential contaminants, as well as for spill response in the event of a breach.
All formal reviews of plans, documentation, and work performed should be recorded for later reference.
Finally, any project is likely to call for changes to at least some of the initial terms. Change requests should be documented for issues large and small, with a record of client acceptance where required. In fact, it’s wise to catalog all project-related correspondence, especially with key stakeholders such as clients or regulators. Evidence of communications and approvals can be the most effective defense against potential claims.
Mining the data in documentation
One secondary benefit to a successful documentation strategy is the wealth of information that it offers to insurance carriers and underwriters assessing the quality of a potential insured. Risk managers should review consultants’ procedures against those described and address any gaps before contacting insurers.
In addition to routine application requests for financial information and loss history, risk managers can provide copies of standard operating procedures, site reports, incident response and spill containment plans, hazardous material storage protocols, subcontractor qualifications and resumes of specialists responsible for core operational and oversight functions.
For environmental consultants, incorporating these recommendations increases the likelihood of successful projects and productive client relationships — outcomes that translate into improved availability and affordability of insurance. For insurance professionals, evaluating risks in light of these standards can reduce claim frequency and severity, improving loss experience and underwriting results.
The combined effect is enhanced profitability for carriers, producers, and consultants themselves and greater availability of essential environmental services for the economy as a whole.
According to the World Health Organization, mental health is described as: “a state of well-being in which every individual realizes his or her own potential, can cope with the normal stress of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” But the World Health Organization’s definition applies only to part of the population.
At any given time, one-in-five American adults suffer from a mental health condition that impacts their daily lives. Stress, anxiety, and depression are among the most prevalent for injured workers. Left untreated they can render a seemingly straightforward claim nearly unmanageable, resulting in poor outcomes and exorbitant costs.
Increasingly, many in our industry are recognizing the need to proactively do all we can to address this critical issue. We must openly discuss and gain a deep understanding of a subject that until now has been taboo.
Four prominent workers’ compensation experts helped us advance the conversation on mental health in the workers’ comp system during a recent webinar. They were:
- Bryon Bass, senior vice president for disability, absence, and compliance at Sedgwick
- Denise Zoe Algire, director of managed care and disability for Albertsons Companies
- Maggie Alvarez-Miller, director of business and product development at Aptus Risk Solutions
- Brian Downs, vice president of quality and provider relations at the Workers’ Compensation Trust
Why it matters
Mental health conditions are the most expensive health challenges in the nation, behind cancer and heart disease. They are the leading cause of disabilities in high-income countries, accounting for one-third of new disability claims in western countries. These claims are growing by 10% annually.
In addition to the direct costs to employers are indirect expenses, such as lost productivity, absenteeism, and presenteeism. Combined with substance abuse, mental health disorders cost employers between $80 and $100 billion in these indirect costs.
In the workers’ comp system, mental health conditions have a significant impact on claim duration. As we heard from our speakers, these workers typically have poor coping skills and rely on treating physicians to help them find the pain generator, leading to overutilization of treatments and medications.
More than 50% of injured workers experience clinically-related depressive symptoms at some point, especially during the first month after the injury. In addition to the injured worker himself, family members are three times more likely to be hospitalized three months after the person’s injury. Many speculate that the distraction of a family member leads the injured worker to engage in unsafe behaviors.
Mental health problems can affect any employee at any time and the reasons they develop are varied. Genetics, adverse childhood experiences and environmental stimuli may be the cause.
The stress of having an occupational injury can be a trigger for anxiety or depression. These issues can develop unexpectedly and typically result in a creeping catastrophic claim.
One of our speakers relayed the story of a claim that seemed on track for an easy resolution, only to go off the rails a year after the injury. The injured worker, in this case, was a counselor who had lost an eye after being stabbed with a pen by a client. Despite his physical recovery, the injured worker began to struggle emotionally when he finally realized that for the rest of his life he would be blind in one eye. Because his mental health concerns were raised one year after the injury, there were some questions about whether he might be trying to game the system.
Such stories are more commonplace than many realize. They point out the importance of staying in constant contact with the injured worker to detect risk factors for mental health challenges.
Mental health conditions — also called biopsychosocial or behavioral health — often surprise the person himself. Depression can develop over time and the person is not clued in until he finds himself struggling. As one speaker explained, the once clear and distinct lines of coping, confidence, and perspective start to become blurred.
In a workers’ comp claim, it can become the 800-pound elephant in the room that nobody wants to touch, talk about or address. Organizations willing to look at and address these issues can see quicker recoveries. But there are several obstacles to be overcome.
Stigma and social prejudice are one of the biggest challenges. People who do realize they have a problem are often hesitant to come forward, fearing negative reactions from their co-workers and others.
Depictions of people suffering from behavioral health issues in mass media are often negative but are believed by the general public. Many people incorrectly think mental health conditions render a person incompetent and dangerous; that all such conditions are alike and severe; and that treatment causes more harm than good.
As we learned in the webinar, treatment does work and many people with mental health conditions do recover and lead healthy, productive lives. Avoiding the use of negative words or actions can help erase the stigma.
Cultural differences also affect the ability to identify and address mental health challenges. The perception of pain varies among cultures, for example. In the Hispanic community, the culture mandates being stoic and often avoiding medications that could help.
Perceptions of medical providers or employers as authority figures can be a deterrent to recovery. Family dynamics can play a role, as some cultures rely on all family members to participate when an injured worker is recovering. Claims professionals and nurses need the training to understand the cultural issues that may be at play in a claim, so they do not miss the opportunity to help the injured worker.
Another hurdle to addressing psychosocial issues in the workers’ comp system is the focus on compliance, regulations and legal management. We are concerned about timelines and documentation, sometimes to the extent that we don’t think about potential mental health challenges, even when there is clearly a non-medical problem.
Claims professionals are taught to get each claim to resolution as quickly and easily as possible. Medical providers — especially specialists — are accustomed to working from tests and images within their own worlds, not on feelings and emotional well-being. Mental health issues, when they are present, do not jump off the page. It takes understanding and processes, which have not been the norm in the industry.
Another challenge is the fact that the number of behavioral health specialists in the country is low, especially in the workers’ comp system. Projections suggest that the demand will exceed the supply of such providers in the next decade. Our speakers explained that with time and commitment, organizations can persuade these specialists to become involved.
Jurisdictions vary in terms of how or whether they allow mental health-related claims to be covered by workers’ comp. Some states allow for physical/mental claims, where the injury is said to cause a mental health condition — such as depression.
Less common are mental/physical claims, where a mental stimulus leads to an injury. An example is workplace stress related to a heart attack.
“Mental/mental claims” mean a mental stimulus causes a mental injury. Even among states that allow for these claims, there is wide variation. It typically hinges on whether an “unusual and extraordinary” incident occurred that resulted in a mental disability. A number of states have or are considering coverage for post-traumatic stress among first responders. The issue is controversial, as some argue that the nature of the job is itself unusual and extraordinary, and these workers should not be given benefits. Others say extreme situations, such as a school shooting, is unusual enough to warrant coverage.
What can employers do
Despite the challenges, there are actions employers and payers are successfully taking to identify and address psychosocial conditions.
For example, Albertsons has a pilot program to identify and intervene with injured workers at risk of mental health issues that are showing promise. The workers are told about a voluntary, confidential pain screening questionnaire. Those who score high (i.e. are more at risk for delayed recoveries) are asked to participate in a cognitive behavioral health coaching program.
A team approach is used, with the claims examiner, nurse, treating physician and treating psychologist involved. The focus is on recovery and skill acquisition. A letter and packet of information are given to the treating physician by a nurse who educates them about the program. The physician is then asked to refer the injured worker to the program, to reduce suspicion and demonstrate the physician’s support.
Training and educating claims professionals is a tactic some organizations are taking to better address psychosocial issues among injured workers. The Connecticut-based Workers’ Compensation Trust also holds educational sessions for its staff with nationally known experts as speakers. Articles and newsletters are sent to members to solicit their help in identifying at-risk injured workers.
Ongoing communicating with the injured worker is vital. Asking how they are doing, whether they have spoken to their employer when they see themselves returning to work are among the questions that can reveal underlying psychosocial issues. Nurse case managers can also be a great source of information and intervention with at-risk injured workers.
Changing the workplace culture is something many employers and other organizations can do. Our environments highly influence our mental health. With the increased stress to be more productive and do more with less, it is important for employers to make their workplaces as stress-free as possible.
Providing the resources to allow employees to do their jobs and feel valued within the organization helps create a sense of control, empowerment, and belonging. Helping workers balance their workloads and lives also creates a more supportive environment, as does provide a safe and appealing workspace. And being willing to openly discuss and provide support for those with mental health conditions can ensure workers get the treatment they need as soon as possible.
As one speaker said, “By offering support from the employer, we can reduce the duration and severity of mental health issues and enhance recovery. Realize employees with good mental health will perform better.”