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Tuesday, January 31, 2012

An Open Letter to North Dakota

[We've rarely (if ever) weighed in on WC issues, but this case appears uniquely egregious. Our friend Joe Paduda has helped spearhead an effort to better publicize this travesty, and we were happy to lend our support. HGS]

An open letter to the press, business community and people of North Dakota:

The authors of this letter are journalists, columnists, bloggers and content publishers for the workers' compensation industry across the United States. We are a politically and professionally diverse group. We do not agree on everything, yet find ourselves of one opinion on a highly critical matter. We are competitors who are now colleagues for a common cause; to bring light to a serious injustice being committed within your state.

The prosecution of Charles (Sandy) Blunt was, in our view, an outrageous and almost farcical event. It is, in the final analysis, a travesty that has damaged the national view of your state, hampered the operation of a State agency, and ruined the life of a good man wholly undeserving of such results.

Sandy Blunt was Director of North Dakota's Workforce Safety & Insurance from May of 2004 until December of 2007. He was, as you are likely aware, prosecuted by state authorities for "misspending government funds". Specifically, he was charged and convicted on two counts:

During his almost 4 year tenure his agency spent approximately $11,000 on employee incentive items, including flowers, trinkets, balloons, decorations and beverages for Workforce Safety and Insurance employee meetings, and on gift certificates and cards in small denominations for restaurants, stores and movie theaters. Blunt personally approved some of these expenditures. Others were made by managers as part of daily operations under his watch. Not a dime went into an employee's pocket, nor did Blunt personally benefit from any expenditure.

His agency paid $8,000 to an employee, David Spencer, for sick pay when he was not apparently sick, and it also failed to collect $7,000 from Spencer when he left prior to the end of his employment agreement. The $7000 was for moving expenses incurred that prosecutors felt Spencer owed the state. Blunt's position was that the agency was not entitled to collect these funds, since Spencer's departure was not voluntary.

All told, the state prosecuted Sandy Blunt, and he is now a convicted felon for "misspending" $26,000 of government money.

No one has ever alleged that Blunt personally benefited from any of these expenditures. Blunt was acting like other capable, ethical North Dakota executives ‐ in the best interest of customers and of the mission of his employer. In our industry it is considered a best practice to provide employees and supervisors with incentives. It is not frivolous, it's necessary, and what every employer should do.

The first of these two charges would be, to many people, laughable if it were not for the damaging consequences associated with them. The notion that buying inexpensive incentive items for your employees could result in a felony conviction is simply stunning. This would not be elevated to a criminal status in most states in the nation. The fact that it is in North Dakota should have a chilling effect on businesses looking to move there.

The second and more serious charge, involving the sick pay and moving expenses of employee Spencer, has been fatally undermined by the revelation that the prosecutor in the matter, Cynthia Feland, withheld critical evidence from the defense - evidence that largely clears Blunt in this area. A disciplinary panel for the North Dakota Supreme Court has found on November 7, 2011 that:

"Cynthia M. Feland did not disclose to Michael Hoffman, defense attorney for Charles Blunt, the Wahl memo, and other documents which were evidence or information known to the prosecutor that tended to negate the guilt of the accused or mitigate the offense."

Withholding of evidence by prosecutors is one of the most serious acts of prosecutorial misconduct in North Dakota and all other states. In recognition of this, the panel recommended Ms Feland's license to practice law be suspended. We urge that you read the entire report of the panel, including the penalties the board recommended be imposed on Ms. Feland. For the report, go here.

Had the prosecutor not withheld evidence, in all likelihood the case would never have come to trial, and the reputation of Blunt and the WSI would be free of taint. The evidence in question shows that WSI's auditor's own findings backed Blunt's position on payments related with Spencer. However, those findings were not made available to the defense, and the prosecutor was found to have allowed testimony to be given at the trial that directly conflicted with information she had. As we indicated, Feland, now a judge in your state, has been recommended for suspension and a fine over these findings.

Yet Sandy Blunt remains a convicted felon. His crime? Buying balloons, trinkets and $5 gift cards - for his employees, not for himself. For that, Blunt, who is married with two children, has had to spend half a decade, and untold thousands of dollars trying to clear his name.

Some of us have known Sandy for quite a while. Some have come to know him while learning of his situation. Others of us have never met Sandy, but recognize the tenuous nature of his treatment. Collectively we speak to thousands within our industry every day. Our opinions have been clear; this situation needs the light of truth shone brightly upon it. The time and resources expended prosecuting a man on such questionable grounds should be more closely examined, by the business community, workers compensation professionals and the media in North Dakota.

Sandy Blunt is a good and decent man. He deserves better. So, it would seem, do the people of North Dakota.

Peter Rousmaniere
Consultant & Writer
Working Immigrants

Robert Wilson
President & CEO
workerscompensation.com

Joseph Paduda
Principal, Health Strategy Assoc, LLC
Managed Care Matters

Rebecca Shafer
Lower Your WC Costs

Julie Ferguson
Consultant & Editor
Workers' Comp Insider

David DePaolo
President & CEO
Work Comp Central

Henry Stern, LUTCF, CBC
InsureBlog

Tom Lynch
Founder & President
Lynch, Ryan & Associates, Inc.

Jon Coppelman
Senior Vice President
Lynch, Ryan & Associates, Inc.

OmniCare in the News, Again!

Well, that was fast. Previously, it took over three years between OmniCare posts; this time it's less than three weeks:

"PharMerica Corp. said Monday it hopes ... Omnicare Inc. will drop its $457 million takeover bid in the face of the federal government's suit late Friday to block the deal ... The Federal Trade Commission said a combination of the nation's two biggest long-term care pharmacies would raise the cost of Medicare Part D prescription plans"

Hey, wait a minute.

Did I just hear the gummint say that competition is a good thing and that fewer choices is a bad one?

Has anyone clued in HHS Secretary Shecantbeserious?

Because that's exactly the opposite of what she's been advocating.

[Hat Tip: FoIB Holly R]

Potter strikes (out) again

Wendell Potter, erstwhile shill for Cigna turned professional insurance industry basher, is at it again. This time, he's using the tragic death of skier Sarah Burke to indict our health care system. There are many, many holes in his diatribe, but we'll highlight a trio:

"The irony is that had the accident occurred in Canada… her care would have been covered because, unlike the U.S., Canada has a system of universal coverage"

Really?

Please tell that to Kent Pankow, little Baby Joseph, and pregnant women. The truth is that the Canadian system may offer universal coverage but has a dim track record on actual delivery .

"but with medical care covered through donations, the aftermath will not bring them additional hardship"

And so?

There are a number of lessons here: first, why would Mr Potter expect the surgeons who worked on Ms Burke to do so for free? Second, we obviously have the infrastructure here to handle these kinds of incidents, paid for by Americans. So in Mr Potter's world, it would have been perfectly fair for American citizens to be stuck with the bill for her care, because she chose not to purchase readily available travel medical insurance?

Sheesh.

Finally, Potter pulls out the ol' "medical bankruptcy" canard, long debunked, by claiming that "An estimated 700,000 American families file for bankruptcy every year because of medical debt."

No they don't, Wendell, and you (should) know it.

I'd ask this question of Mr Potter: how do you think Ms Burke would have fared had ObamneyCare© and its death panels been in full force?

Yeah, I thought so.

We're THIS many (7)!

Hard to believe, but today marks our 7th blogiversary.

With over 4,750 posts, numerous awards, and a top-shelf selection of co-bloggers, we have a lot to celebrate.

Most important, of course, are our wonderful, loyal readers.

Thank You all!

Monday, January 30, 2012

ObamneyCare© vs The Constitution

While (almost) all eyes have been on the constitutionality of the (Evil) Individual mandate, another constitutional issue is hitting the radar, and it's pretty powerful:

"Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law."

Seems pretty benign and banal, no?

It is anything but:

"Dear Brothers and Sisters in Christ:

I write to you concerning an alarming and serious matter that negatively impacts the Church in the United States directly, and that strikes at the fundamental right to religious liberty for all citizens of any faith. The federal government, which claims to be “of, by, and for the people,” has just been dealt a heavy blow to almost a quarter of those people — the Catholic population — and to the millions more who are served by the Catholic faithful."

At issue is the requirement, about which we wrote this past fall, that health insurance plans pay for abortions and birth control, with no deductibles or co-pays.

There are several issues at play here. We've already debunked the idea that this coverage is "free." But that's not even the worst of it. Catholics are not the only constituency that forbids artificial birth control: approximately 845,000 Orthodox Jews would be affected by this trampling of the First Amendment, as well. As for abortion, well, that's against Catholic doctrine, and not a few Christian denominations, as well.

And according to at least one source, abortion is also forbidden by Islam.

Which begs the question: ACLU, where art thou?

Walgreens Makes a Funny

Last time we looked, Walgreens was in the process of slitting its own wrist. The good news is, we recently received snail-mail [copy available here] from them detailing how we can help them retain their customer base.

The bad news is, of course, that I don't work for Walgreens.

In a particularly tone-deaf plea for assistance, we're told that "[o]pportunity for selling Small Group plans with an integrated pharmacy benefit can ensure your clients access to Walgreen's in 2012" [underline in original]

First, no employer really cares which pharmacies are included in any particular plan. They are concerned primarily with the prohibitively high cost of small group plans, and are looking for ways to reduce them. They're further challenged by the fact that small group plans are "off the rack;" that is, there is precious little customization available, and no carrier (to our knowledge) offers multiple pharmacy provider options. You get what's packaged.

But never fear, "Walgreen's has put together a comprehensive education program to reach patients who may be expressing concerns to their employers." Which is nice, but employers have also rolled out a comprehensive education program to reach their employees with such concerns: "this is our group plan. Feel free to sign this waiver if you don't like it."

Walgreeen CCO (Chief Client Officer) Joe Terrion provides us with handy "Talking points for Health Insurance Brokers;" these include the statement that "pharmacy access is an important consideration for small group." Um, not so much, Joe.

But -- and here's where I literally laughed out loud -- (Slow) Joe continues, groups "can easily switch to competitively priced health plans that provide access to a broad network of pharmacies, including Walgreens."

Uh-hunh.

Here's a question, Mr T: what color is the sun in the sky above your planet? Because here, medical underwriting has tightened up, premiums have sharply increased while choices have sharply decreased, and employers are looking for ways to minimize the damage. I have yet to have any employer ask me about what pharmacies are included in any particular carrier's offerings.

No one but Walgreens cares, and as I pointed out at the beginning, I don't get paid to shill for them.

Open wide and say....ObamneyCare©

Writing in this month's issue of Health Insurance Underwriter magazine (not the swimsuit issue), Ameritas Sr VP Karen Gustin opines about how dental plans will fare under ObamneyCare©. We've addressed this issue before, when we took to task Companion Life's cave-in on "young adult" coverage. At the time, we pointed out that dental plans are specifically excluded from this requirement.

In fairness, what the law (purportedly) says and how it's implemented by HHS Secretary Shecantbeserious are often at odds, so it may not have been completely unreasonable for Companion to have acted pro-actively at the time.

Still, that was then, this is now, and Ms Gustin previews the year ahead as regards dental coverage under the current regime:

■ Dental care for children: as with the medical parts of ObamneyCare©, there will be a core "essential" benefits component, the make-up of which is still being considered.

Dependent tracking: this one's disturbing. New requirements will be rolled out detailing employers' responsibilities to track their employees' dependents and how (or even if) they're covered. This is part of new compliance requirements that, frankly, sound even worse than the Individual Mandate (who even thought that was possible?).

Fee integration: aka new taxes. 'Nuff said.

Employee education: aka Brainwashing. Ms Gustin's point is that the law (ostensibly) requires only juvenile coverage and there's concern that as they age off these plans, folks will forgo needed care. Or, as we call it, personal responsibility.

There's more, and the article is definitely worth the read. Maybe in the dentist's office?

[Hat Tip: SoIB Gail S]


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Friday, January 27, 2012

Fourth Circuit Rules in Favor of Insurer That Refused to Defend Inmate

Fourth Circuit Rules in Favor of Insurer That Refused to Defend Inmate
Finds Inmate Is Not Covered as a “Volunteer Worker”

Post by Logan Wells
On January 20, 2012, in an unpublished opinion, the United States Court of Appeals for the Fourth Circuit ruled in favor of an insurer that refused to defend an inmate in a lawsuit over a West Virginia jail worker’s injuries, reversing a decision by the United States District Court for the Southern District of West Virginia. 

In National Union Fire Insurance Co. of Pittsburgh, Pa. v. Lambert, Hale, the plaintiff in the underlying suit, sought damages for injuries she allegedly sustained as a jail worker when an inmate working alongside her in the jail kitchen allegedly caused a mixer to fall and land on Hale’s foot. Notified of Hale’s suit, National Union filed a declaratory judgment seeking a declaration that it had no duty to defend or indemnify the inmate, Lambert, with regard to the underlying action. Specifically, National Union argued Lambert did not constitute an “insured” under the terms of the policy, which defined “persons insured” as follows:

(A) The “Named Insured” [i.e., the State of West Virginia],
(B) Any elected or appointed official, executive officer, commissioner, director, or member of the “Named Insured” while acting within the scope of his duties as such,
(C) Any faculty member, employee, volunteer worker or student teacher of the “Named Insured” while acting within the scope of their duties as such.
(Emphasis added). In response, Hale asked the court to declare that Lambert was an insured “volunteer worker” under the policy and therefore entitled to a defense and indemnification. Lambert independently sought an identical declaration. National Union and Hale filed competing motions for summary judgment. The district court sided with Hale, finding that Lambert qualified as a volunteer worker under the policy. National Union appealed.

The Fourth Circuit reversed the judgment of the district court, stating it was “convinced that Lambert, a prison inmate, cannot possibly meet the definition of ‘volunteer worker’ as found in the policy...” Finding the term “volunteer worker” is unambiguous, the court considered the appropriate contours of its meaning, holding that “absence of coercion is the thread uniting the disparate definitions of ‘volunteer’”:

We first look to the “common and customary meaning,” Boggs v. Camden-Clark Mem’l Hosp. Corp., 693 S.E.2d 53, 58 (W. Va. 2010), of “volunteer.” Freedom from coercion and absence of legal obligation compose the bedrock of definitions of “volunteer.” For instance, Black’s Law Dictionary defines “volunteer” as “[a] voluntary actor,” one who acts “[u]nconstrained by interference . . . [or] outside influence” and has no legal obligation. Black’s Law Dictionary 1711 (9th ed. 2009). Webster’s defines “volunteer” as “a person whose actions are not founded on any legal obligation so to act” and who acts “by free choice[,] . . . without compulsion or obligation.” Webster’s Unabridged Dictionary 2131 (2d ed. 2001). And in the federal statutory context, the Fair Labor Standards Act (“FLSA”) considers as volunteers only those individuals whose “services are offered freely and without pressure or coercion, direct or implied.” 29 C.F.R. § 553.101(c).
Thus, the court reasoned, to be considered a “volunteer worker,” Lambert must have elected to work of his own volition.

Noting Hale and Lambert’s argument “obscure[d] the broader portrait of institutional confinement, which is hallmarked by the Jail’s coercive authority over inmates like Lambert”, the court looked to West Virginia statutes and the nature of Lambert’s confinement to determine whether Lambert’s work in the jail kitchen was volitional:

A close look at West Virginia statutes and the nature of Lambert’s confinement reveals that his work in the kitchen was anything but voluntary. As an initial matter, Lambert conceded that he was obligated to work at the Jail in some capacity. The Jail’s policy is wholly consistent with West Virginia law, which requires inmates to participate in jail work assignments, W. Va. Code R. § 95-1-21.3. Because Lambert was compelled to work at the Jail, he cannot be considered a “volunteer worker” under the Policy.
The nature of incarceration and the jail-inmate relationship further underscores that Lambert is by no means a “volunteer worker.” We have emphasized that, “[b]ecause . . . inmates are involuntarily incarcerated, the [jail] wields virtually absolute control over them to a degree simply not found in the free labor situation of true employment.” Harker v. State Use Indus., 990 F.2d 131, 133 (4th Cir. 1993); accord Vanskike v. Peters, 974 F.2d 806, 810 (7th Cir. 1992) (“[T]here is too much control to classify the [jail-inmate] relationship as one of employment.”). Because a volunteer generally enjoys more freedom than an employee and courts uniformly hold that a jail’s absolute authority over an inmate precludes a finding that an inmate is an employee, we have little trouble concluding that an inmate is not a “volunteer worker.” Indeed, Lambert’s thwarted protest provides a case study in the coercive authority of jails. Whereas a volunteer worker under the ordinary meaning of the term would have been free to leave his shift at his discretion without suffering a concrete penalty, Lambert was put in “the hole” for five days when he refused to finish his kitchen shift. At bottom, the Jail’s “virtually absolute control” over Lambert, Harker, 990 F.2d at 133, which renders Lambert’s status as a worker something approximating involuntary servitude, Vanskike, 974 F.2d at 809, yields an impossible fit between his role and the definition of “volunteer worker.”
That Lambert succeeded in his efforts to obtain a work assignment in the kitchen does not undermine his exclusion from Policy coverage. To be sure, Lambert submitted an application to work in the kitchen out of a desire “[t]o eat extra food and to get out of [his] cell.” J.A. 118. But his ability to express an assignment preference does not convert the overarching obligation to work from required to optional. See Burleson v. California, 83 F.3d 311, 314 (9th Cir. 1996) (“[P]laintiffs mistakenly equate the ability to choose between various work programs offered by the [jail], with the freedom to ‘sell’ their labor.”). Had Lambert failed to submit an application or had the Jail denied his request to serve in the kitchen, he still would have been forced to work in some capacity. Nor does Lambert’s choice to apply for a job in the kitchen alter the Jail’s broader coercive authority and “virtually absolute control” over him, see Harker, 990 F.2d at 133, factors that we find make Lambert anything but a “volunteer worker.”
Accordingly, the court rejected Hale and Lambert’s argument and found that the common and customary meaning of “volunteer worker” foreclosed Lambert’s classification as an “insured” under the policy.
For those who are interested in whether the Fourth Circuit’s reasoning would apply to a similar case in South Carolina, it is interesting to note that South Carolina has a statute similar to the West Virginia regulation the court examined in coming to its decision in Lambert. Compare W. Va. Code R. § 95-1-21.3 (“Inmate option to refuse. Inmates may refuse to participate in jail facility programs, except work assignments and programs required by statute or court order. There shall be written documentation of each refusal to participate maintained in the inmate’s file.”), with S.C. Code Ann. § 17-25-70 (“Notwithstanding another provision of law, a local governing body may authorize the sheriff or other official in charge of a local correctional facility to require any able-bodied convicted person committed to the facility to perform labor in the public interest. ...”). Considering the South Carolina statute together with the nature of institutional confinement as outlined by the Lambert court, it is likely that a South Carolina court’s decision regarding a similar case would be in line with the Fourth Circuit’s opinion in Lambert.

SOTU: ObamneyCare© MIA

Careful listeners might be forgiven if they missed the 44 words covering his signature legislative "victory" in President Obama's most recent State of the Union address. That's correct, 44 words in a speech which, oddly enough, barely qualified as Smarter than an 8th Grader.

Now why would the President elide over his stellar accomplishment?

Well, the fact that 44% of the public disapproves of it (versus 37% who think it's just Jim Dandy). The most hated part? Well, that remains the (Evil) Individual Mandate, which 54% believe (correctly) is unconstitutional.

Which is not to say that the Republicans should rest easy, either. In his rebuttal, Hoosier Gov Mitch Daniels gave the subject short shrift, as well. As Bob pointed out yesterday, the Republicans' plan is not exactly a barn-burner, either.

Still, one is left to wonder why the President was so uncharacteristically modest about the bill we had to pass to learn what's in it.

$howing us the money

Take a gander at this:



There's no question that the cost of health care, both its delivery and the financing thereof, has become an ever-increasing burden on the consumer. Although it's not the primary cause of the problem, ObamneyCare© has certainly exacerbated it, by decreasing consumers' "skin in the game" and choices, and increasing the cost of both health care (scarcity) and health insurance.

Americans are not stupid: they can see the disconnect every time they look at their pay stub or pay their insurance bill, or write a check at the doctor's office. Would that Washington actually understood this.

And couple that with this little tidbit:

"Just 1% of Americans accounted for 22% of health care costs in 2009"

Make of that what you will...

[Hat Tip: Warren Robak]


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