Page 1





NAVIGATING PANDORA’S BOX OF COMORBID CONDITIONS: A Holistic Approach for Proactive Claim Management PAGE 10


Protecting Your Department’s Reputation PAGE 16


You’ve relied upon our financial security and underwriting skill for a long time.

Visit our website at

And along the way, you’ve challenged us to do more. Well, we’ve been listening, and we’re proud to announce a new, more “can do” approach to your business. We’re actively seeking expanded opportunities. So whether you’re seeking broader coverage, new jurisdictions, or aggregate deductibles, we hear you, and it’s time to test our limits. Let’s talk. We’ll fly high together!

Genesis Insurance Company is licensed in the District of Columbia, Puerto Rico and all states. Genesis Insurance Company has its principal business in Stamford, CT and operates under NAIC Number 0031-38962

A.M. Best A++ XV


A Berkshire Hathaway Company

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public administration.

JULY 2018 | Volume 34, No. 6 |


PRESIDENT Jani J. Jennings, ARM Risk Manager City of Bellevue Bellevue, NE PAST PRESIDENT Amy J. Larson, Esq. Risk and Litigation Manager City of Bloomington Bloomington, MN PRESIDENT-ELECT Scott J. Kramer, MBA, ARM City/County Director of Risk Mgmt Montgomery County Commission Montgomery, AL DIRECTORS Brenda Cogdell, AIS, AIC, SPHR Risk Manager, Human Resources City of Manassas Manassas, VA Forestine Carroll Risk Manager Memphis Housing Authority Memphis, TN


Benefits and Challenges of Government Social Media Use By Thom Rickert

Sheri Swain Director of Enterprise Risk Management Maricopa County Community College District Tempe, AZ Donna Capria, CRM, CIC, AINS Risk & Insurance Coordinator WaterOne of Johnson County Lenexa, KS Michael S. Payne, ARM, HEM Risk Manager City of Fresno Fresno, CA Melissa A. Steger, MPA Asst. Director, Workers’ Compensation University of Texas System Austin, TX NON-VOTING DIRECTOR Marshall Davies, PhD Executive Director Public Risk Management Association Alexandria, VA EDITOR Jennifer Ackerman, CAE Deputy Executive Director 703.253.1267 • ADVERTISING Jennifer Ackerman, CAE 703.253.1267 •



Navigating Pandora’s Box of Comorbid Conditions:

Crisis Communications in Law Enforcement:

By Eric Patten

By Julie Frisbey




Public Risk is published 10 times per year by the Public Risk Management Association, 700 S. Washington St., #218, Alexandria, VA 22314 tel: 703.528.7701 • fax: 703.739.0200 email: • Web site: Opinions and ideas expressed are not necessarily representative of the policies of PRIMA. Subscription rate: $140 per year. Back issue copies for members available for $7 each ($13 each for non-PRIMA members). All back issues are subject to availability. Apply to the editor for permission to reprint any part of the magazine. POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314. Copyright 2018 Public Risk Management Association





PRIMA Institute 2018 (PI 18) is the premier educational program for new and seasoned risk management professionals who want to learn more about emerging trends and best practices. PI 18 is an innovative educational symposium comprised of fundamental risk management curriculum, outstanding faculty and excellent networking opportunities.



SMALL SETTING. November 5–9, 2018 • West Palm Beach, Florida


he 2018 PRIMA Annual Conference in Indianapolis can now officially take its place in the “past conferences” category. The amazing conference, in keeping with the whole Indy racecar theme, could be summed up in one phrase: “Who needs brakes? They just slow you down.” During my first week of presidency, I am reflecting on the excitement I felt at this year’s conference—hustling from the general session to the exhibit hall, from educational sessions to meetings, preparing for the luncheon presentations, anticipating swearing in new board members and officially being sworn in myself—it was both exhilarating and a little overwhelming. My first Annual Conference in Dallas in 2009 was a little like that as well. I was finally able to personally meet all the PRIMA committee members to whom I had been having monthly phone meetings. The educational sessions were the best I had ever attended and I quickly wore myself out, trying to stretch every last minute out of each day. I was hooked on PRIMA. PRIMA welcomed 260 first-time attendees to this year’s conference, and I had an opportunity to meet and chat with many of them. I could almost spot them from a distance. You know… the ones with the wide eyes and big smiles. They couldn’t wait to offer what they had learned so far. They wanted to tell me about the keynote speaker, their dilemma in choosing one session over another, the lovely venue, and the song they chose for karaoke at Punch Bowl Social! Like a baby who has just finished that first taste of ice cream, they were eager for more! The same can be said about the two new board members installed, Melissa Steger and Michael Payne. Board orientation day offered another

Whether we are a newcomer or a seasoned risk manager who has cut their teeth on PRIMA, engaging with PRIMA to take that next step can breathe new life into your profession…


Shiny Happy People

opportunity to see the enthusiasm and passion they brought. It was rejuvenating. Little did they know that each time they offered a question, their energy became contagious and refreshed me in the midst of a busy day.

• Apply for the Board of Directors. Would you like to ensure PRIMA remains the premier educational resource for public risk managers? Consider applying to serve as a PRIMA board member.

Whether we are a newcomer or a seasoned risk manager who has cut their teeth on PRIMA, engaging with PRIMA to take that next step can breathe new life into your profession:

If you ask a creative person how they continue to innovate, they’ll tell you the key to their success is a commitment to trying new things. When you try new things, you put your brain into unique situations that force it to really think. This stimulates creativity, which eventually carries over in other areas of your life. As a result, you begin to think about everything in a new light.

• Brush up on skills. Do you need to learn more about ERM implementation? Consider taking PRIMA’s ERM training using the ISO 31000 standard. • Identify a mentor. Did you meet someone at conference who you would like advisement from? Developing a bond with other risk managers can help provide solutions to your day-to-day challenges. • Share the knowledge. Seasoned risk managers have the opportunity to contribute to the membership by writing a blog, a magazine article, or present an educational session at the Annual Conference. • Take on a new role as a PRIMA committee member. Sometimes the best way to learn about an organization is to volunteer for an organization.

Allow PRIMA to bring about a new level of excitement to your career and to your world. Sincerely,

Jani Jennings, ARM PRIMA 2018-2019 President Risk Manager City of Bellevue, NE




NEWS Briefs

The Kilauea volcano on Hawaii’s big island erupted in May, sending a plume of ash 30,000 feet into the sky after fissures had spewed molten rock into residential neighborhoods for the previous two weeks, destroying dozens of structures and forcing thousands to evacuate. In the Pacific Northwest, nearly 38 years to the day since the eruption of Mount St. Helens, volcano experts said lessons from that deadly volcanic discharge are informing the reaction to the events in Hawaii. Seth Moran, a seismologist and head scientist at the Cascades Volcano Observatory, said the Mount St. Helens eruption on May 18, 1980 showed how quickly a seemingly nascent volcano can lead to catastrophe. The Kilauea eruption hasn’t reached catastrophic levels yet, but the pace with which it has developed shows the need for readiness. “Three weeks ago, everything was normal. Two weeks ago we began to see lava coming out of the ground,” Moran said. “These crises can evolve very quickly.” The last major eruption of Kilauea was in 1983, though the current activity is technically a part of the same event as the volcano has been consistently spewing lava ever since.

need to do their own social media outreach. The main questions everyone wants answers to are: when the volcano will erupt, how big it will be and how long it will last, Moran said. But answers can be elusive as they relate to the amount of magma beneath the volcano. The best experts can do is come up with educated guesses judging from the “signs and symptoms” that show on the surface, such as fissures and earthquakes. Since the 1980 eruption, volcano observatories have taken a more collaborative approach. When Mount St. Helens erupted in 2004, the Cascades Observatory got help from geologists and seismologists in Alaska and Hawaii. Mount St. Helens is one of 13 volcanic peaks in the Pacific Northwest, stretching 800 miles from Lassen Peak in northern California to Mount Baker in northern Washington. All of those volcanoes are part of the so-called “Ring of Fire,” a term used to describe volcanoes that sit atop tectonic plates. That system is completely unconnected to the Hawaiian volcanoes.

In the aftermath of the St. Helens eruption, Moran said volcano observers learned that one observatory cannot handle the amount of work that comes with an active volcano.

“All our mountains are considered active and, geologically speaking, things seem to happen in the Northwest about every 100 years,” John Ufford, preparedness manager for the Washington Emergency Management Division, told the Associated Press. “It’s an inexact timeline.”

In Hawaii, crews of geologists are out on the ground 24 hours a day monitoring fissures.

In terms of readiness, Moran described his observatory as “OK.”

“That’s exhausting,” Moran said.

“The volcanoes that need monitoring, we keep an eye on as resources allow,” he said. “There are a couple volcanoes in Washington that have limited monitoring where it wouldn’t be great if they woke up right now.”

On top of that, experts are inundated with information requests from news outlets and



ZOMBIE ALERT CONFUSES RESIDENTS AND CITY OFFICIALS A power outage in a South Florida city sparked an alert that left residents wondering if they had awakened to the end of the world. “Power outage and zombie alert for the residents of Lake Worth and Terminus,” the alert read. “There are now far less than 7,380 customers involved due to extreme zombie activity.” The alert was sent at 1:45 a.m. Sunday and referenced the fictional town threatened by zombies in AMC’s television series, “The Walking Dead.” City officials confirmed the alert came from the city, but said the message was altered, WPBF reported. Ben Kerr, communications specialist for Lake Worth, addressed the alert in a message on Lake Worth Live’s Facebook Page. “We are looking into the reports that the system mentioned zombies. I want to reiterate that Lake Worth does not have any zombie activity currently and apologize for the system message,” he wrote.


He went on to say the power issue was fixed in 27 minutes. The post led to a dozen comments poking fun of the alert. “I was in the cone of death, and didn’t even know it. I slept straight through the entire event!!” one person wrote. Another poster: “I feel so relieved and confident at the state of our electrical systems right in time for hurricane season…said no one ever.”

MARIJUANA LEGALIZATION IS COMING AND NYC’S MAYOR WANTS TO PREPARE EVERYONE Mayor de Blasio will tell the NYPD to stop arresting people for public pot smoking—and launch a new group to officially prepare the city for the outright legalization of marijuana in New York. De Blasio, who has long opposed making recreational pot legal, now says he thinks legalization is inevitable and is creating an official task force to get ready for the day when that happens. While pot remains illegal, Hizzoner will direct the NYPD to give summonses to people they catch smoking in public instead of arresting them, his aides said. That policy change will be part of a 30-day review the mayor announced last week to address the massive racial disparity in marijuana arrests. And de Blasio isn’t stopping there—he’ll put together a task force of city officials to lay the groundwork for full legalization, figuring out issues like how cops will deal with public smokers, what kind of zoning will be needed for pot dispensaries, and what types of public health campaigns the city should run about marijuana.

commission to study the issue and saying the availability of legal pot in surrounding states has changed the equation for New York.

Manhattan District Attorney Cy Vance Jr. and Brooklyn DA Eric Gonzalez said they would stop prosecuting almost all possession and smoking cases.

More and more New York pols have gotten on board with legalizing weed in recent weeks, and the city has faced a torrent of criticism over the racial disparity in NYPD arrests. Research shows white and black people smoke pot at about the same rate, but 86 percent of those arrested in the city are black and Latino.

De Blasio’s task force, made up of officials from various city agencies, aims to have policies in place when pot does become legal on education, small business engagement and economic fairness, in addition to policing and the siting of pot distribution facilities.

The NYPD first argued they were making arrests in neighborhoods where residents call to complain about pot smoking—but as the Daily News first reported, data on 311 and 911 calls show the areas with the most calls and the most arrests do not match up. De Blasio previously loosened marijuana enforcement early in his first term, directing police to give summonses instead of arresting people found with the drug in their possession. But people who are smoking it in public still face arrest. Last week, de Blasio promised to “overhaul and reform” the enforcement policy, but gave no details.

The mayor has long expressed opposition to legal pot, even as several states around the country moved to end the ban on the drug. Most recently, he said he feared there would be “giant corporations in the style of the tobacco companies, taking this opportunity and running with it, and with the goal of trying to hook as many young people as possible on marijuana for the profit of those companies. “That has real ramifications for health and safety and that has to be addressed,” he said on the Brian Lehrer radio show. De Blasio’s spokesman said he is reexamining his position, but proceeding on the assumption legalization will happen regardless of his personal views.

De Blasio isn’t quite throwing his support behind legalizing pot, but says the day is coming—whether he likes it or not—and the city should be ready.

Now, the mayor’s office says the city will be moving to summonses instead of arrests for smoking as well. It’s unclear when the new arrest policy will take effect.

“With marijuana legalization likely to occur in our state in the near future, it is critical our city plans for the public safety, health and financial consequences involved,” he said.

The NYPD is also expected to come up with other initiatives to address the racial disparity, but those have not been determined yet.

“While I still have real concerns we must work through, it isn’t difficult to see where this is headed, and any responsible policymaker must prepare for that eventuality. My focus now will be helping to craft the critical regulatory framework that must come before legalization is realized.”

With marijuana legalization likely to occur in our state in the near future, it is critical our city plans for the public safety, health and financial consequences involved.

Cuomo, like de Blasio, has opposed legalization. But he has shifted his position, appointing a

City Hall is acting because they believe Gov. Cuomo is likely to act soon to make the drug legal in New York State.

“The mayor is taking a hard look at it and he believes it’s where we are headed. Regardless, he’ll definitely have a voice in crafting the critical regulations as this process develops,” said press secretary Eric Phillips.

New York City Mayor Bill de Blasio





Social media has become today’s town square, local newspaper and neighborhood coffee shop rolled into one. BY THOM RICKERT




ust as fictional TV newsman Ted Baxter on The Mary Tyler Moore Show had humble beginnings (“It all started at a 5,000-watt radio station in Fresno, California”), so did social media. Emerging as bulletin board systems (BBS), progressing to platforms like CompuServe and AOL, then transforming to the now-ubiquitous Facebook, LinkedIn and Twitter, social media has evolved from a unique space for narrowly focused hobbyists to the medium of choice for information sharing.

And as social media use grows in popularity, local governments are under considerable pressure to keep up. The benefits are clear. For example, social media can be a cost-effective communications tool for cash-strapped municipalities looking to fulfill mandates, increase public participation and encourage greater social activism. But the profound public nature of social media—the posting and sharing of vast amounts of information, the direct interaction with more and more citizens—may pose threats to privacy and other basic constitutional rights.


Pinterest, Instagram, YouTube and others have become essential communications vehicles for the public and, in turn, are equally vital to the institutions that serve it.


Today, besides people using it to share the latest cute kitten video or network with like-minded professionals, local governments are using social networking platforms to reach out to their citizens.

A city in Canada has experimented with a mobile app that lets people know when their streets will be cleared of snow. A small town in Spain uses Twitter to connect citizens directly with public works personnel in the field. A public health department in Ohio uses social media to share the latest information about the H1N1 virus.

Local governments using social media to engage with their communities can enjoy many benefits. The platforms can increase citizen participation in local decision-making, enhancing the public perception of the town, its leaders and staff. Local businesses, schools and nonprofits gain exposure by informing people about events, activities and fundraising efforts. Law enforcement gains support for its efforts to report and monitor public safety.

A growing number of municipalities are discovering the value of social media for interacting with their citizens. Some public entities favor the swift and efficient exchange of ideas—a throwback to the open public forums that once defined engagement in towns across America. Facebook, Twitter, blogs, LinkedIn,

Many cities and towns now routinely use social media to: • Host and share results of town halls and council meetings. • Aid crime prevention and other policing activities. • Deliver construction and road-closure updates.




• Broadcast emergency alerts and severe weather updates. • Promote events and activities. • Make public service announcements. • Recruit employees. It is estimated that more than 85 percent of the 75 largest cities in the U.S. utilize social media, according to Rutgers. It has now filtered down to smaller cities and towns, with more than 50 percent in some studies reporting a high level of use of at least two platforms.

facilitates between public officials and the people they serve. The law has not yet determined that social media constitutes a public forum, yet it may be prudent to assume this is the case. Frequently, inquiries are made as to whether it is legally acceptable to attempt to shut down a social media voice who doesn’t agree with you or who criticizes your decisions and operations. It is inappropriate to restrict the First Amendment rights of citizens, elected officials and municipal employees about a public concern.

Material published to a site—even if later taken down—may

continue to exist in some format. Potential coverage issues could arise in the event that a claim for damages involves previous publication years. THE CHALLENGES OF SOCIAL MEDIA

Although it has its benefits, all technology creates challenges and responsibilities. Cities should define what objectives they want to achieve with social media and align their presence with those goals. Commonsense policies and procedures should be written and broadly shared within departments. While some larger governments now have employees specifically hired to act as “social media coordinators,” most towns continue to administer their social media presence ad hoc. If you don’t have a staff position dedicated to social media, identify a heavy user who, with some training, will be willing to act as your “social media ambassador.”


Understanding the legal implications is also crucial. Research your state’s policies for local governments on open meetings, public records and retention. Be aware of First Amendment implications, and remember that your archive policies must meet Freedom of Information Act requirements. Social media’s greatest strength may lie in the power of expression and the dialogue that it



Material published to a site—even if later taken down—may continue to exist in some format. Potential coverage issues could arise in the event that a claim for damages involves previous publication years. In other key coverages for public entities—such as public official errors and omissions, law enforcement liability, and employment practices liability—exclusions and limitations may apply (for example, an exclusion or limitation for claims seeking injunctive relief). This continues to be an emerging risk area. Most insurers are monitoring the legal environment to determine if future adjustments in underwriting analysis, risk management best practices and coverage provisions will be needed.

SOCIAL MEDIA AS AN EFFECTIVE PUBLIC SAFETY TOOL They are entitled to express their opinions. But that comes with limits, and certain postings clearly fall outside the boundaries of protection—partly due to what constitutes a public concern. Personal attacks, personnel disputes and individual job grievances, for example, are not considered fair game. Everyone should be instructed to use proper channels to discuss them. The policy should also be reviewed and approved by local legal counsel. But it’s meaningless if no one knows it exists. Social media policies are particularly important to publicize, since most people in the organization use various networking platforms. Some public entities require staff to sign a form indicating they have read and will comply with the policy by—among other things—being professional, truthful and considerate in what they post.

SOCIAL MEDIA AS AN EMERGING INSURANCE RISK AREA The law remains fluid on social media. But that’s also the case regarding insurance. A municipality using Twitter, Facebook or other types of third-party sites does not own or host the site. But a group or feature page may constitute something that it exercises control over.

Don’t let the challenges discourage your town from participating in social media. Citizens appreciate the information on severe weather and road closures, town meeting reminders, and the general opportunity to talk (yes, even virtually) with town leaders and fellow citizens. Even more importantly, recent events—from multiple catastrophic hurricanes to the California wildfires—have shown how well-thought-out social media communication plans can enhance emergency management and response. Governments’ growing use of social media in areas such as public safety comes as an increasing number of people view it an important function. In the past two years, the number of citizens who believe governments should prioritize integrating digital services with social media doubled to 40 percent, according to Government Technology magazine in citing a report by Hootsuite. Governments’ use of social media can be a great benefit to communities. The key is ensuring it’s done right to help avoid legal issues and other potential pitfalls. Thom Rickert, CPCU, ARM, ARM P, ARM E, ARC, ARe, is the vice president, Head of Marketing for Trident Public Risk Solutions.

Healthcare Providers, Better Protected. At Liberty Mutual Insurance, we understand the healthcare industry and are committed to providing integrated solutions to protect your organization from evolving and complex exposures. To learn more, talk to your broker.

COMMERCIAL AUTO • EMPLOYER STOP LOSS • GENERAL LIABILITY • NETWORK SECURITY AND PRIVACY • MANAGEMENT LIABILITY LINES • MEDICAL STOP LOSS PROFESSIONAL LIABILITY • PROPERTY • REGULATORY RISKS • SITE POLLUTION INCIDENT LIABILITY • TERRORISM • WORKERS COMPENSATION Some policies may be placed with a surplus lines insurer. Surplus lines insurers generally do not participate in state guaranty funds and coverage may only be obtained through duly licensed surplus lines brokers. © 2018 Liberty Mutual Insurance. Insurance underwritten by Liberty Mutual Insurance Co., Boston, MA, or its affiliates or subsidiaries.



BY ERIC PATTEN he term “Pandora’s box” calls to mind how something quite ordinary, like opening a box, can lead to unpredictable, complicated consequences. That’s how many risk managers feel about workplace injuries that are seemingly low-risk and routine, but quickly spiral out of control due in part to claims involving comorbid factors.

For workers’ compensation claims, injured workers with comorbid conditions describes the presence of one or more diseases or disorders that existed prior to injury or may develop during treatment. Obesity, diabetes, hypertension, depression, tobacco use and substance abuse are all common examples of comorbidities. Awareness of these conditions—beyond the work-related injury—provides a holistic view of the patient’s health and the ability to contain medical costs and improve outcomes.




Before opening your box, you must first read the directions. To identify potential spiraling claims and measure their risk, information needs to be collected at the onset of the injury and assessed throughout the life of the claim. This information should be used to develop a comprehensive medical management approach. One of the complexities that exists today is when comorbid conditions are present, they may have an adverse impact on the compensable claim. Although the mere existence of comorbid conditions can adversely influence treatment and recovery, generally it is only the compensable claim that is covered. To provide a holistic view of the full impact an injury has on the injured worker, all factors, including pre-existing comorbid conditions, should be examined when assessing claim risk‚ compensable or not. Another challenge facing workers’ compensation programs is the ability to identify spiraling claims. While the risk of catastrophic cases is easier to determine, non-catastrophic claims have a greater need for evidence-based medicine guidelines and predictive analytics to determine which claims may be high risk and in need of case management. A truly interdisciplinary approach to case management, including the workers’ compensation case manager and group health case manager is especially important due to the presence of comorbid factors. Consider this scenario: A 69-year-old female who works full time stood up from her desk, turned and fell, resulting in a stress fracture of the foot. The treating physician recommended four-to-six weeks in a boot non-weight bearing. Initially, one would think this is not a high risk claim. However,

prior to her injury, she suffered from a variety of comorbidities including obesity, hypertension and type 2 diabetes.

DO YOU KNOW THE COMORBID CONDITIONS AFFECTING YOUR WORKERS’ COMPENSATION PROGRAM? • Obesity – By 2030, 51 percent of the U.S. population is expected to be obese1

Without proactive claim management, these types of claims on average experience: • • • • •

• Diabetes – 30.3 million Americans have diabetes, another 84.1 million have prediabetes and 90 percent of this population is unaware they have the disease2

Longer claims duration Higher medical and indemnity costs More temporary disability days (TTD) Increased litigation rates Increased surgery rates

• Hypertension – About 75 million U.S. adults have hypertension and only half have their blood pressure under control3

Moreover, although the frequency of claims decrease with age, aging workers are more likely to have one or more comorbid conditions. Older employees with comorbidities such as diabetes, arthritis and heart disease are common, making treatment more complex and costly. With 69 percent of the aging population working past 65 and half never expecting to retire, this trend poses a specific set of challenges for workers’ compensation programs. Furthermore, a study performed by Harbor Health Systems, reveals that claims with multiple comorbidities experienced a 341 percent increase in total incurred costs.

• Depression – Every year, approximately 15.7 million adults in the U.S. have at least one major depressive episode4 • Tobacco Use – 37.8 million adults in the U.S. smoke cigarettes and more than 16 million live with a smoking-related disease5 • Substance Abuse - 11.5 million people misused prescription opioids in 20166

An injured worker with one or more conditions can drastically change expected outcomes. If left unmanaged, comorbidities can complicate claims by impeding an injured worker’s ability to recover, which often results in higher indemnity costs.

TOTAL INCURRED COSTS BY COMORBID CONDITION AGAINST CONTROL GROUP $23,784 $14,672 $12,226 $10,709 $8,703 $7,818 $3,512 $2,429 0

5,000 Multiple Comorbidities


10,000 Mental Health

15,000 Addiction


20,000 Diabetes

25,000 Tobacco





DO YOU KNOW THE FINANCIAL IMPACT OF UNHEALTHY EMPLOYEES? • Each year, the U.S. loses $225.8 billion in productivity due to absenteeism7 • People with chronic and mental health conditions account for 86 percent of the $2.7 trillion in annual health care expenditures8 • Diagnosed diabetes costs the U.S. $327 billion annually - $237 billion in direct medical costs and $90 billion in reduced productivity12 • Drinking too much alcohol accounts for $249 billion in costs including losses in workplace productivity and health care expenses10 • Obese or overweight workers with chronic health conditions linked to $153 billion in annual lost productivity costs11 • Cardiovascular diseases and stroke total more than $316 billion in health expenditures and lost productivity9


• Early Identification – The increasing incidence of comorbid factors requires early intervention in the claims process to allow for safer and more effective care. Understanding how the comorbidities impact the outcome gives the employer, provider, injured worker and payer more realistic expectations for recovery and return to work. With early intervention, nurse case managers can help by leveraging their expertise and identifying preexisting comorbid conditions that could impact the need for clinical intervention or ongoing oversight throughout the case. Predictive analytics can help payers screen claims for a host of characteristics, including the existence of comorbidities, to identify patterns and predict potential outcomes. Once high-risk claims are identified, payers can establish protocols for managing them long term to reduce the risk of rising medical and indemnity costs.

The presence of comorbid conditions can complicate even the simplest of workers’ compensation claims… To help mitigate those risks, it is important to remember to identify comorbid conditions early. Utilize tools and data to hone in on the comorbid conditions that affect your employees. Armed with this information, create an operational plan to impact those conditions. A holistic approach to care management, including the injured worker’s primary care physician; group health nurse case manager, PBM and workers’ compensation care manager, must be taken to ensure the best outcome not only for the claim, but for the injured worker.



• Clinical Coordination – Claims with comorbid factors must be managed from multiple perspectives to provide injured workers with timely and appropriate clinical coordination. Whether the injured worker needs home care, medical equipment, diagnostics, physical therapy or transportation, a system-wide approach is needed to oversee these claims. Utilizing a workers’ compensation care management company to facilitate these services as well as clinical oversight, bill review and utilization management can help streamline care. Pharmacy Benefit Management (PBM) companies should also be considered to holistically manage medications and overall health of injured workers. There is evidence that shows that the number of medications prescribed to an individual increases, so does the risk for contraindications. Therefore, it is imperative that medications prescribed for comorbid conditions be considered when prescribing injury related medications. • Wellness Programs – In some cases, potential side-effects from comorbid conditions may be minimized with proactive wellness programs. Offerings may include post-offer employment testing, bike-to-work, smoking cessation, weight management or discounts on health club memberships. Wellorganized programs with an aim to motivate employees to improve their health behaviors are the most successful. There are many types of incentives companies can incorporate into their wellness program to help promote behavior change. Incentives can be benefits based, providing discounts on healthcare premiums or extra paid time off, or include gift cards and prizes. Once successfully implemented, the changed behavior can help to reduce the risk of complications from comorbid conditions as well as absenteeism and overall costs. The presence of comorbid conditions can complicate even the simplest of workers’ compensation claims. Prevalence of diabetes,

obesity, hypertension and various other comorbidities contributes to the risk of prolonged healing times, increased time to return to work and higher overall claims costs. To help mitigate those risks, it is important to remember to identify comorbid conditions early. Utilize tools and data to hone in on the comorbid conditions that affect your employees. Armed with this information, create an operational plan to impact those conditions. A holistic approach to care management, including the injured worker’s primary care physician; group health nurse case manager, PBM and workers’ compensation care manager, must be taken to ensure the best outcome not only for the claim, but for the injured worker. Eric F. Patten RN, B.S.N., is the senior director of clinical and education services for One Call Care Management.


1 May 2012. Centers for Disease Control and Prevention. CDC Weight of the Nation Press Briefing. releases/2012/t0507_weight_nation.html. 2 July 2017.Centers for Disease Control and Prevention. New CDC Report: More than 100 million Americans have diabetes or prediabetes. p0718-diabetes-report.html. 3 May 2018. Centers for Disease Control and Prevention. High Blood Pressure. 4 September 2017. Substance Abuse and Mental Health Services Administration. Behavioral Health Treatments and Services. 5 Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults in the United States. tobacco/data_statistics/fact_sheets/adult_data/ cig_smoking/index.htm. 6 Substance Abuse and Mental Health Services Administration. Why Do Adults Misuse Prescription Drugs. default/files/report_3210/ShortReport-3210.html.

7 January 2015. CDC Foundation. Worker Illness and Injury Costs U.S. Employers $225.8 billion Annually. pr/2015/worker-illness-and-injury-costs-usemployers-225-billion-annually. 8 2010. Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook.[PDF – 10.62 MB] AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality. 9 2017. American Heart Association. Heart Disease and Stroke Statistics 2017 At-a-Glance uploads/2017/06/Heart-Disease-and-StrokeStatistics-2017-ucm_491265.pdf. 10 2015. Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 National and State Costs of Excessive Alcohol Consumption. 11 October 2011. Gallup. Unhealthy U.S. Workers’ Absenteeism Costs $153 billion. http://news. 12 2017. American Diabetes Association. The Cost of Diabetes. news-events/cost-of-diabetes.html.


PRIMA PODCASTS! PRIMA’s Podcasts are a quick and convenient way to learn on-demand and on your own time!

Meant to provide you with information on specific topics important to the public risk management sector and hot topics, PRIMA Podcasts are the perfect way to fit in education and training into your busy schedule.

Check for new Podcasts!

CURRENT PODCAST TOPICS INCLUDE: Comorbid Conditions The Aging Workforce













Further your public sector risk management education without leaving the office! This Webinar series features top presenters delivering risk knowledge to your desktop!


WEBINAR SERIES PRIMA WEBINARS ARE FREE FOR MEMBERS! Visit today to register for individual Webinars or for the entire program!

J U LY 18 | 1 2 : 0 0 P M – 1 : 3 0 P M E ST PRIVATE EVENT AND POST-EVENT SAFETY SPEAKER: Marilyn L. Rivers, CPCU, ARM, AIC, Director – Risk and Safety/City Safety and Compliance Officer, City of Saratoga Springs, NY DESCRIPTION: Private – community events define a public entity’s socioeconomic culture, beckoning the potential for tourists, trade, visitors and possible business. More often than not, the events bring additional costs to governance and often cause strife as municipalities attempt to recoup costs of overtime to manage the health and safety of events for not only the taxpayers, but everyone else attending the event. Public safety has become the number one issue of reviewing and approving events for our communities. Achieving consensus is difficult at times, when events are marketed as benefitting a cause of financial assistance for a well-known loss. This webinar will beg questions and thoughtful conversation as to how municipalities can work toward achieving community safety while giving a platform to private community events. AT T E N D E E TA K E AWAYS :  Learn to identify the risks of private – community events as they relate to your municipality’s operations and safety.  Recognize the relationships of stakeholders in your government structure as you review and approve events.  Understand the limitations of your municipality’s application process for private – community events.  Question the parameters for managing the safety and risks associated with private – community events.

For more information, or to register, visit



UR CURRENT DIGITAL AGE OF SMARTPHONES, SOCIAL MEDIA AND 24-HOUR NEWS COVERAGE HAS INTENSIFIED PUBLIC SCRUTINY OF LAW ENFORCEMENT. In the aftermath of any given crisis, the reaction of the public and media to a department’s involvement can be unpredictable. The handling of the situation can make or break the credibility of a department; at best solidifying a positive reputation and at worst, causing the organization to be perceived as inept or criminally negligent. One perceived wrong action can increase the potential risk of exposure to a department’s reputation as well as the liability exposure for the public entity as a whole. However, if a department maintains a clear policy and willingness to operate with transparency and accountability, a seemingly negative or complicated narrative can be positively dealt with, positioning the department as trustworthy and credible leaders in the community. Whether your agency has faced a major crisis or not, there are some concrete steps that you can take to help reduce the adverse reactions and impacts during a crisis, such as being proactive and developing a strategy to effectively communicate with the public, media, and other key stakeholders.




If your law enforcement agency does not already employ a Public Information Officer (PIO), it may be time to consider hiring one. A PIO position requires a strong background in written and verbal communication as the primary role is to distribute information to the public and to act as your departments’ chief spokesperson. During a crisis, only individuals designated as spokespersons should be authorized to speak publicly. A department may identify more than one spokesperson, typically including the senior officer. All spokespersons should be well-trained on how to respond to questions to prevent misunderstandings and establish credibility and trust with the media, public, and key stakeholders. Now that you’ve identified your department spokesperson(s), you’ll want to consider establishing a communications response team.

If and when a crisis occurs, this team will help develop key messages for each audience, as well as determine what information may or may not be disclosed. Disclosing specific facts may increase your departments’ liability in any future claims.


It’s best not to wait for a crisis to occur before having a clear communication strategy in place. Consider including the following when developing your plan: Training: First and foremost, train all officers and agency staff on the communications protocol including posting to social media and talking to reporters or friends and family. A firm policy will help ensure everyone knows who to contact in the event of a crisis and what details to communicate immediately. Vet all of your information before being




releasing anything publicly to be sure you aren’t unnecessarily increasing the exposure of your officers or department. Officers sharing misinformation on their social media accounts or to reporters can cause confusion within your community which is why it’s critical to leave the crisis communications up to the designated spokesperson(s).

A crisis can happen at any moment, and there is no time like the present to prepare for one. However, each crisis is unique in its own way. By developing a plan and a communications response team, you can drastically minimize slow reactions or the need to hastily throw a strategy together.

Include in your strategy an in-depth social media policy for all department staff. A social media policy doesn’t just help manage a crisis; it can protect the safety of your officers. Notification System: Establish a notification system to allow for the immediate release of information; this may include a system that is triggered by a single call, email or button. Consider utilizing social media, email, text messages, auto phone prompts and TV/Radio broadcast announcements as your avenues of communication. Holding Statements: Develop your holding statements well before a crisis happens. A holding statement is an all-purpose response you provide to the media that ensures the public and stakeholders that you are aware of the crisis and are addressing the issue. This statement will buy you additional time to prepare a briefing on the incident, including basic facts. Review your holding statements periodically to determine if they require updating or to determine if you need to develop new statements for other scenarios. “The Golden Hour”: This refers to the first hour of any given crisis. During this time, eyes are directly on how your department responds, and this response will impact the perception of your community, the media and your staff. To prepare for this hour and to ultimately reduce the impact of the crisis, consider creating a response checklist from collecting the basic facts and determining priorities to developing a response strategy. During the golden hour, an initial public statement, such as a holding statement, should be made.


While there are several “dos” outlined above, it’s important to remember that there are plenty of “don’ts” to keep in mind too. When it comes to a crisis situation, take a deep breath but don’t do the following: Do not panic: A crisis typically instills fear in the public which is why it’s extremely important for the spokesperson to remain calm. Panicking will convey to the public and media that you do not have things under control.



Do not lie or speculate: During the early stages of a crisis, your department will be under fierce scrutiny. Ensure that everything you say is fact and if you are unsure, refer your audience to another trusted source such as a doctor, fire department, etc. Speculating can create distrust and confusion that may later hurt the credibility of your spokesperson and department. Do not disappear: During a crisis, it is important to stay present. Provide updates, guidance, and support. It can be tempting to avoid the media, which may be overwhelming with their questions, but the aftermath of hiding may lead to worse consequences for your department. Do not make jokes: Crises are serious situations. Do not try to make light of the situation with an ill-humored joke. Stay genuine, calm and respectful. Pay attention and most of all listen to the public’s concerns, claims and questions. Be proactive and stay positive about the plan in place. Do not be unprepared: No one ever expects a crisis to happen to them but, when one does, being prepared will result in the best outcome possible. The most reliable way to handle any crisis is to be proactive through training, policies and the creation of a crisis response team. Reactive strategies can lead to poor crisis management. A crisis can happen at any moment, and there is no time like the present to prepare for one. However, each crisis is unique in its own way. By developing a plan and a communications response team, you can drastically minimize slow reactions or the need to hastily throw a strategy together. A welltrained team will be able to work together in a time of crisis to determine the best approach to move forward. If your law enforcement department can do this, then you will be well positioned to handle any crisis that may come your way. Julie Frisbey is a senior risk management field consultant with OneBeacon Government Risks.



Genesis Management and Insurance Services Corporation. . . . . . . . . . . . . . . . Inside Front Cover Liberty Mutual Insurance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . page 9 Munich Reinsurance America. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Back Cover Rimkus Consulting Group, Inc.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Inside Back Cover

CALENDAR OF EVENTS HAS YOUR ENTITY LAUNCHED A SUCCESSFUL PROGRAM? An innovative solution to a common problem? A money-saving idea that kept a program under-budget? Each month, Public Risk features articles from practitioners like you. Share your successes with your colleagues by writing for Public Risk magazine! For more information, or to submit an article, contact Jennifer Ackerman at or 703.253.1267.

PRIMA’s calendar of events is current at time of publication. For the most up-todate schedule, visit



June 9–12, 2019 PRIMA 2019 Annual Conference Orlando, FL Gaylord Palms June 14–17, 2020 PRIMA 2020 Annual Conference Nashville, TN Gaylord Opryland June 13–16, 2021 PRIMA 2021 Annual Conference Milwaukee, WI Wisconsin Center

PRIMA INSTITUTE November 5–9, 2018 West Palm Beach. FL

ISO 31000 TRAINING November 14–15, 2018 Alexandria, VA The Alexandrian Hotel

Keep up with what’s happening at PRIMA and connect with your risk management peers! Visit us at




You Know Risk Management is Valuable. Why Doesn’t Everyone? Introducing the PRIMA

VALUE OF RISK MANAGEMENT SERIES Public sector risk management is often not well understood or supported by other public entity staff and policy makers. To overcome this, we must be able to measure the value of risk management and communicate it to others This five webinar series provides you with the tools to do exactly that. TOPICS INCLUDE: Module 1 — Overview Module 2 — Total Cost of Risk Module 3 — Risk Maturity Models Module 4 — The Risk Appetite and Risk Tolerance Framework Module 5 — Strategies for Communication and Change Management In addition to the webinars, PRIMA members will also have access to reference guides and case studies.

For more information, visit

Public Risk July 2018 Issue  

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public adminis...

Public Risk July 2018 Issue  

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public adminis...