Sedgwick Connection

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The quantum mechanics of a CMS-approved Medicare set-aside

In my spare time, I enjoy reading and learning about the strangeness of the subatomic world. Quantum theory is difficult to understand and really hard to believe because it is counterintuitive and contrary to what we witness in reality. Quantum physics provide us with such terms and phrases as: wave-particle duality, The Higgs Boson, Schrodinger’s cat, Plank’s law, quantum tunneling, and supersymmetry, among many others. For a brief (five-minute) look into the irrational world of quantum physics

Prescribing trends to watch: Psychotropics

Jailhouse heroin, Suzie Qs, Squirrel, Quell, Baby heroin, Maq-Ball (marijuana + quetiapine) or Q-ball (cocaine + quetiapine) – these are all street names for a prescription drug called quetiapine. Quetiapine is an antipsychotic medication that antagonizes serotonin, dopamine, histamine and the alpha-1 receptor, and it is used for the treatment of bipolar disorder, major depressive disorder and schizophrenia. Psychotropic agents like quetiapine have been traditionally used for the treatment of s

Choices

This week, I spoke at the WCI 2018 conference in Orlando regarding the choices we make and the impact they have both short- and long-term in our lives, our careers and the lives of others we connect with each day. Currently, you have a choice to read this synopsis or, instead, view the video of my full speech. Each of us has a moral compass or set of values that guide us. Our parents or mentors provide advice on what we should do in life. Society has created expectations about how we should int

Subsidence watch 2018

With locations around the world tracking record-setting temperatures and hazardous drought conditions persisting in places such as the Pacific Northwest, Scandinavia and parts of Australia, where the drought has been considered to be among the worst the continent has endured, it should not be surprising to hear we are experiencing what may be the fourth hottest summer to ever be recorded. Unfortunately, this continuous heat and abnormally dry weather has resulted in dangerously dry soil conditio

Greater than the sum of our parts

On April 16, Sedgwick announced the completion of the Cunningham Lindsey acquisition. Although the activity leading up to this important notice was significant, we knew that the real advantages for our clients would come in the near future.  Sedgwick’s origins are rooted in the U.S. workers’ compensation market. In the decades following our founding in 1969, we broadened our focus to include disability and absence management, managed care, liability and other claims specialties. Thanks to

Real-life examples: Surgery nurse services are providing long-lasting benefits for patients

Rita, a 48-year-old patient, was preparing for outpatient surgery when surgery nurse, Paula, was assigned to support her case. Paula learned during their initial discussion that Rita had a heart attack at age 44, which raised concerns – pre-op cardiac testing had not yet been done for clearance, and this patient with heart attack history was scheduled for outpatient instead of inpatient surgery. Paula contacted the surgeon and he immediately scheduled testing with a cardiologist and changed the

Massachusetts now poised to offer paid family and medical leave

Following recent legislation signed by Governor Charlie Baker, Massachusetts is now preparing for a new paid family and medical leave requirement. This program, known as the Massachusetts Paid Family and Medical Leave (MA PFML), makes Massachusetts the sixth state to make paid family leave a requirement – following California, New Jersey, New York, Rhode Island and Washington State. As directed by the legislature, premium payments begin on July 1, 2019 and benefits can be taken st

Espionage, terrorism and disruption: Coverage complexities in an era of uncertainty

Espionage, terrorism and disruption: Coverage complexities in an era of uncertainty Business owners are faced with scenarios today that would have been almost unthinkable just a year ago – or only in Tom Clancy novels from the 1980s. Yet, this year on March 4, Sergei Skripal and his daughter, Yulia, were found collapsed on a bench in the city of Salisbury in Wiltshire. They had been poisoned using Novichok, a nerve agent secretly developed in the Soviet Union, which is one of the most deadly ch

Telemedicine is a great option – but buyer be aware

Employers considering telemedicine as a treatment option for occupational injuries can anticipate its advantages, but should be aware of two important things:     Have an experienced clinician providing care direction. Some state regulations have not caught up with this innovative treatment option. Experienced guidelines-based guidance Telemedicine is a useful treatment option for minor occupational injuries. It is also very convenient for recheck appointments and final

Maine employers do not have to pay for medical marijuana

On June 14, 2018, the Maine Supreme Judicial Court issued a much-anticipated ruling in Gaetan H. Bourgoin v. Twin Rivers Paper Company, LLC, et al that reversed an order requiring an injured employee to be reimbursed for the cost of medical marijuana. This workers’ compensation claim is managed by Sedgwick. In a 5-2 decision, the court held that where an employer is subject to an order that would require it to subsidize an employee’s acquisition of medical marijuana, there is a positive conflic

​Holiday hoaxes: Taking on travel fraud in the U.K.

Summer holiday season is here and, in the U.K., that has meant an increased vigilance for our fraud team. Over the last few years, fraudulent gastric illness claims against U.K. travel operators reached epidemic proportions. Travel trade association ABTA estimated a claims increase of 434% since 2013, hitting a peak during the end of 2016 and beginning of 2017. While the industry acknowledges many holiday sickness claims are genuine, the significant increase in numbers during this period was fu

One millionth morphine equivalent dosage MED

In late 2011, a team of claims management and managed care leaders at Sedgwick met to identify how they could address the troubling rise in opioid prescriptions and morphine equivalent dosage (MED).  What followed was the development of a team of doctors, pharmacists and specially trained nurses engaged to educate prescribers and patients and to formulate weaning plans and identify alternative therapies for cases with adverse drug trends.  Through the efforts of this team, we have s

Early nurse engagement

Early nurse engagement makes a valuable impact in 3 key areas Recent analysis of Sedgwick’s claims data shows that employers using 24/7 clinical consultation for workplace injuries saw 34% lower incurred costs than those using an intake process without a nurse triage service. Engaging a nurse immediately after an injury occurs can help ensure the employee receives the appropriate treatment and recovers as quickly and safely as possible.   Identifying the right care Employers evaluat

Generic vs. brand name prescription drug costs – how much could you save?

About three years ago, we posted the article, “Could you cut $185,000 from your MSA?” The crux of this article was that by simply changing one drug from brand name to generic, you could save $185,000 from the cost of a Medicare Set-aside (MSA). We provided a chart of the top 10 costliest drugs and their generic alternatives (if available) to show the stark difference between the two pricing models.  Well, after three years, a few things have changed: Abilify, Nexium and Pristiq now h

Cyber attack claims: stick or twist?

Cyber crime is rarely far from the headlines these days. From the alleged Russian state sponsored attack of the U.S. Democratic party, to the attack on the U.K. telecoms giant, Talk Talk, the number of incidents are clearly on the increase and the perpetrators are employing increasingly sophisticated methods to commit them. Let’s take a high-level look at the basics of cyber incidents and the things employers must be mindful of when addressing their risk. What types of attacks do we commonly se

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