tlrt IIISlIrtlnCt IIBII'st «ccldents tlf wo,,, lI11d occlIPtlflOIlIl ... · • Contribution of 2.25% of the average salary (1.25 ... SOCSO. Social Security Organisation of Malaysia

EUROPEAN FORUM

*** * * * * * * ***

of tlrt IIISlIrtlnCt IIBII"'st «ccldents tlf wo,,,

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"' DGUV Deutsche Gesetzliche Unfallversicherung Spitzenverband

Adding Value through International Cooperation Conference, Dresden June 21 to 22, 2011

TU ESDAY, jUNE 21

1.00 p.m .

7.00 p.m.

Conference opening

Moderator: Mr. Carlos Andres Angel Arango, Ca/ambia

Dr. Rolf Ellegast, Germany . Dra. Yanet Zapata Tamayo, Ca/ambia · Mrs. Chandra Cansino, Be/ize

Dinner Reception: "Vive Le Roi"

WEDNESDAY, jUNE 22

9.00 a.m.

1.15 p.m .

1.30 p.m.

2.15 p.m.

Moderator: Ms. Dominique Dressler, Austria

Mr. Felix Weber, Switzer/and . Dr. Mohammed Azman, Ma/aysia · Ms. Mary van lishout, Ire/and

Moderator: Dr. Franz Terwey, Be/gium

Mr. Rafael Haeflinger, France . Mr. Carlos javier Santos, Spain · Mr. HolgerTrechow, Germany . Ms. Katrin Boege, Germany

Closing ofthe Conference

Lunch Buffet

Post-Conference Events: • Workshop ofthe European Academy of Dermatology and Venereology (EADV) on the

initiative "healthy skin@work" (English language) • Guided tour ofthe international training center of the Institute for Work and Health

(lAG) (English language)

tt • • AddingValue through

International Cooperation Conference, Dresden June 21 10 22, 2011

14:00-18:00

15:00-17:00

18:00-18:30

18:30-19:30

19:30

21,06,2011

9:00-17:00

9:00-10:00

10:00-12:00

12:00-13:00

13:00-13:30

13:30-15:00

15:00-15:30

15:30-17:30

19:00

Registration

Sessions of working groups of the European Forum (Forum members only)

Bus transfer: conference site - inner city

Guided tour of beautiful, baroque Dresden (English language)

Traditional dinner at "Sophienkeller im Taschenbergpalais" in the historie inner city

Registration

T ea and Coffee

Annual General Assembly of the European Forum (Forum members only)

Lunch Buffet

Opening of the Forum Conference by Forum-President Dr. Joachim Breuer (Germany)

Blue Panel: Insurance

Moderator: Dr. Stefan Zimmer, Director International Relations Department, DGUV, German Social Accident Insurance (Germany)

What challenges lie ahead of accident insuranees, worldwide? How are different insurance models (private, public, self-insured) performing? What lessons can be learned by other insurance systems? Dr. Hector Upegui, Senior Consultant, Center of Competence Workers' Compensation, MuniehRe (Germany) Mr. Greg Krohm, PhD, Executive Director, lAIABC, International Association of Industrial Accident Boards and Commissions (USA) Mr. D. Alan McClain, President of lAIABC and CEO ofthe Workers' Compensation Commission of the State of Arkansas (USA)

Coffee break

Green Panel: Prevention

Moderator: Carlos Andres Angel Arango, Vice President Social Security, Suramericana (Colombia)

Our panellists will demonstrate the benefit of multi-national research activities for a healthier working environment and the need for more international cooperation in prevention.

Dr. Rolf Ellegast, Head of Ergonomies Unit, IFA, Institute for Occupational Safety and Health (Germany) Dra. Yanet Zapata Tamayo, Technical Manager, ARP SURA accident insurance (Colombia) Mrs. Chandra Cansino, Manager, Employment Injury Services, Social Security Board (Belize)

Dinner Reception "Vive Le Roi" with surprise acts (marquee in the court yard)

I!I • AddingValue through

International Cooperation Conference. Dresden /une 21 to 22. 2011

22.06.2011

9: 00-09:30

9:30-11:00

11 :00-11 :30

11:30-13:00

13:15-13:30

13:30-14:15

14:15-15:30

Tea and Coffee

Orange Panel: Rehabilitation and Return to work

Moderator: Ms. Dominique Dressler MA, Head International Relations, AUVA, Austrian Workers' Compensation Board (Austria)

The panellists will discuss good practices in rehabilitation and return to work and their suitability for implementation in other national settings.

Mr. Felix Weber, Member of the Executive, SUVA, Swiss National Accident Insurance Fund (Switzerland) Dr. Mohammed Azman, Deputy Chief Executive Officer, Social Security Organization (Malaysia) Ms. Mary Van Lieshout, Head of Research and Standards Development, NationalDisability Authority (Ireland)

Coffee break

Red Panel: Added value of international cooperation

Moderator: Dr. Franz Terwey, President, ESIP, European Sociallnsurance Platform (Belgium)

Summing up the findings of the conference the panel will discuss the benefits and challenges of international cooperation as weil as feasible strategies to pursue it.

Mr. Rafael Haeflinger, Director, Eurogip - Understanding Occupational Risks in Europe (France) Mr. Carlos Javier Santos, Coordinator General, OISS, the Ibero-American Organization of Social Security (Spain) Mr. Holger Trechow, Head of Section, GVG, the Association for Social Security Policy and Research (Germany) Ms. Katrin Boege, Senior Expert, lAG, the Institute for Work and Health (Germany)

Closing of the Conference

Lunch Buffet

Post-Conference Events: • Workshop of the European Academy of Dermatology and Venereology (EADV) on the

initiative "healthy skin@work" (English language) • Guided tour of the international training center of the Institute for Work and Health (lAG)

(English language)

European Forum Of The Insurance Against Accidents At Work

And Occupational Diseases

Abstract: RTW ‐ The Malaysian Perspective ‐ Is it an investment?

By Dr. Mohammed Azman Bin Aziz Mohammed

The presenter will give a brief overview of the Social Security Organisation of Malaysia and its

benefits under social insurance schemes. The main topic of this presentation would be the

Return to Work (RTW) Program, which was introduced by SOCSO to rehabilitate workers who

have been injured during work; and also those seeking invalidity pension. The RTW program is

basically a disability management program; which is a collaborative process that facilitates

recommended efficient treatment plans to assure that the appropriate medical care is provided

to disabled, ill or injured individuals. It is also about planning and coordination of health care

services appropriate to achieve the goal of medical rehabilitation. The program may include,

but is not limited to, care assessment, including personal interview with the client, and

assistance in developing, implementing and coordinating a medical care plan with healthcare

providers, as well as the clients and his/her family, and evaluation of treatment results while

promoting cost‐effective care. The presenter will also share experience in terms of socio‐

economic benefits and how it has impacted the related stakeholder due to disability of an injury

or a disease.

Social Security Organisation of Malaysia

European Forum Of The Insurance Against Accidents At Work And Occupational Diseases

Adding Value Through International Cooperation

RTW ‐

The Malaysian Perspective ‐

Is it an investment?

DR. MOHAMMED AZMAN BIN AZIZ MOHAMMED

Deputy Chief Executive Officer

SOCIAL SECURITY ORGANIZATION MALAYSIA (SOCSO)

[email protected]

21‐22 June 2011

Dresden, Germany

1


2

• Overview on SOCSO

• SOCSO’s RTW Program– Chronology– Concept– Legal Mandate

• Returns? Investment?

• Conclusion

Scope of Presentation


Malaysia

Capital: Kuala Lumpur

Land Area: 329,845sqm

Population: 28million (approx.)

Climate: Tropical (avrg. 33 degrees Celsius), Rain and shine all year round.



Overview of the Social Security Organisation, Malaysia

(SOCSO)


• Statutory Organisation governing

Employment Injury Insurance Scheme &

Invalidity Pension Scheme in Malaysia.

• CORPORATE GOAL ‐

To provide

comprehensive social security

protectionprotection

for Malaysians.

• CORPORATE OBJECTIVE ‐

To ensure

and guarantee the timely and adequate

provision of benefits in a socially just

manner and to promote occupational to promote occupational

health and safetyhealth and safety.

SOCSO


• Currently insuring 13.2 million workers & 727,744 employers

(All workers with income of RM3000 (≈

€700) and below).• Contribution of 2.25% of the average salary

(1.25% Employment Injury Scheme –

Funded by Employer & 1% for Invalidity Pension scheme –

Equally Shared by Employer &

Employee)• Manage over 78,000 Claims/per year

• Over 55,000 accidents • Over 13,000 permanently disabled• Over 10,000 Claiming for invalidity (≈3000 certified invalid)

SOCSO


SOCSO’s Return to Work Program


ChronologyIntroduction of

the RTW

Program.

Appointed

Service

Providers with

biopsychosocial

rehabilitation

approach.

Focus on

Physical

Rehabilitation

Introduction of

5 Disability Case

Managers

(Pilot) under the

Medical &

Rehab

Department of

SOCSO

Covering 2 States

1st

RTW

Conference

Additional of

another 5

Disability Case

Managers

(10 Case

Managers)

Establisment of

a Job Placement

Unit

Covers 5 States

International

Collaboration

2 Case

Managers were

sent to

Germany for 3

months

Additional of 25

Case Managers(Total 35)

Cover all states

2nd

RTW

Conference

Professional

Certification (15

CDMPs)

Deployment of

the RTW Client

Management

System (similar

to Weller‐

Table)

Established as a

RTW Dept.

3rd

RTW

Conference2005 2007 2008 2009 2010


Case Management is a collaborative process that facilitates

recommended efficient treatment plans to assure the

appropriate medical care is provided to disabled, ill or injured

individuals.

Planning and coordination of health care services appropriate to

achieve the goal of medical rehabilitation. Medical case

management may include, but is not limited to, care

assessment, including personal interview with the client, and

assistance in developing, implementing and coordinating a

medical care plan with healthcare providers, as well as the

clients and his/her family evaluation of treatment results while

promoting cost‐effective care.

Concept of Case ManagementCase Management is a collaborative process that facilitatesfacilitates

recommended efficientefficient

treatment plans to assure the

appropriate medical careappropriate medical care

is provided to disabled, ill or injured

individuals.

Planning and coordination of health care services appropriate to

achieve the goal of medical rehabilitationachieve the goal of medical rehabilitation. Medical case

management may include, but is not limited to, care care

assessmentassessment, including personal interview with the client, and

assistance in developingin developing, implementingimplementing

and coordinating a coordinating a

medical care planmedical care plan

with healthcare providershealthcare providers, as well as the

clientsclients

and his/her familyhis/her family

evaluation of treatment resultsevaluation of treatment results

while

promoting costpromoting cost‐‐effective careeffective care.


RTW

Service Providers

Coordinating Treatment/Rehabilitation

Related Stakeholders

(employers, family, etc

Insurer (SOCSO)Facilitate


Section 40 (1) The Organization may, in addition to the scheme of

benefits specified in this Act, promote measures or co‐ operate with existing institutions for the improvement of the health, occupational safety and welfare of

insured persons and for the rehabilitationfor the rehabilitation

and rere‐‐ employmentemployment

of insured persons who have been

disabled or injured and may incur in respect of such measures expenditure from the funds of the

Organization within such limits as may be prescribed by the Minister.

Legal Mandate


Section 57 (1) An insured person suffering from or claiming to

suffer from invalidity or permanent disablement may be provided by the Organization, free of charge facilities free of charge facilities

forforphysicalphysical

or vocational rehabilitationvocational rehabilitation.

(2) Facilities under subsection (1) shall be of such nature nature and scaleand scale

and shall be provided to such insured persons

and on such conditions as may be specified by theregulations.

Legal Mandate


Returns? Investment? You decide

Results


N = 4256

Results


Represents a Client

Disability Durations

56.76% Reduction (Avg)56.76% Reduction (Avg)

Impairment

1.92% Reduction (Avg)1.92% Reduction (Avg)

Without CM With CM


Cost vs ReturnsCost Analysis

Average Program Cost per Insured Person RM3,239.38

Average Possible Returns RM7,884.06

Net Benefit of(RM7,844.06 –

RM3,239.38)= RM4,644.68

Other Social

(qualitative) Benefits

+

DM program

benefits outweigh

costs by a 1.43 : 1

ratio.

N = 1008


Before After

Skills 5.12 6.42

Career Goals 5.10 6.45

Independence 6.00 7.20

Self Esteem 5.93 7.10

Self Confidence 6.03 7.47

Health Condition

5.56 6.86

Pain Tolerance 6.04 7.15

VAS –

100mm

Clients’

Status


Before After

Depression 14.64 8.21

Anxiety 13.21 7.04

Stress 14.93 8.75

Clients’

Status


Insured Person’s Perception

Very Good 12.77%

Good 59.57%

No Benefit 27.66%


Employer’s Perception

Very Interested 8.78%

Interested 76.35%

Willing to consider 4.05%

Not Interested 10.81%


• Fiscal Aspects• Addressing Health/Disability• Psychosocial Improvements• Employees’ Perception• Employers’ Perception

Returns of RTW/DM Strategies

Conclusion

• Work is a social right!

• The ultimate objective of social security systems is to honour benefits when they are due ‐

First of all, the

Social Security System must be sustainable.

• A Social Security System which include

and not exclude.

• Investing in People – Creating Opportunities, not sympathy.


Yes – Oui – Sí – Ya ‐ (Shi)


Returns? Is it an investment?

Thank you


Social Security Organisation

+6 03 4264 5480

[email protected]

www.perkeso.gov.my

Breaking Down Barriers and Moving ForwardBreaking Down Barriers and Moving ForwardReturn to Work Conference Return to Work Conference ––

Kuala Lumpur 2011Kuala Lumpur 2011

Venue: Putra World Trade Centre (PWTC), 4Venue: Putra World Trade Centre (PWTC), 4thth

––

55thth

July 2011July 2011www.rtwmalaysia.com

PERKESOPERKESO

International OSH Seminars at the Institute for Work and Health, Dresden

Katrin Boege, Senior Expert

International Cooperation, IAG

In the area of globalization

Safety and Health not only a national issue

DGUV cooperates at international levelDGUV cooperates at international level

IAG received delegations from Russia, Turkey, Italy, Korea,

Singapore..

IAG expertise

Training courses for:

Labour inspectorsLabour inspectorsSafety officersOccupational physiciansTrainers in occupational safety and health

Increasing international cooperation

leads to growing demand for international

seminars

International Seminars

•OSH Management Systems

•Labour Inspection•Labour Inspection

•Basic Occupational Health

•Risk Assessment

•Train-the-Trainer


• Modules last 1 – 2 days


•In English

•In other languages translated from German •In other languages translated from German

Practical facilities

Ergonomics

Noise Woodwork

Metalwork

Why International Seminars?

DGUV's policy of internationalizing prevention work

OSH standards may be exported in the medium term

DGUV´s autonomous administration's objective:

Making the world of work more humane

Questions? Interested? Contact us

Katrin Boege

International Cooperation and International Trainings International Cooperation and International Trainings

Institute Work and Health

01099 Dresden

Email: [email protected]

Phone: +49 351 4571124

Fax: +49 351 457201124

Katrin Boege

Short Abstract:

In the era of globalization, safety and health at the workplace are not merely a

national issue. For this reason, the DGUV and its institutes co-operate with numerous

institutions and organizations at international level. The IAG has already trained OSH

experts from Russia, Italy and Turkey, just to name a few. Delegations from Korea,

Singapore and China have also sought information on the IAG's training provision.

This led to the idea of offering training which is tailored specifically to the needs of

prevention experts in other countries. In this presentation, the international seminar

programme will be presented together with some of the ideas underlying the rationale

of this form of international cooperation.

Chandra Cansino

My presentation will give an overview of Accident Insurance for work related accidents in Be-lize. Since I fall more in the category of need for more international cooperation, the presenta-tion will highlight the areas that my country needs or can use some collaboration as well as dis-cuss some of the things we already have in place. I will also share a little information on Beli-ze.

09.06.2011L:\CONITZER\FORUMDresdenJun2011\Redner_Abstract\green_panel_prevention\Cansino\Cansino_abstract.doc

Accident Insurance The Belize experience

1

Adding Value through International Cooperation

Conference, DresdenJune 21 to 22, 2011

Presentation Overview

1.

Some quick facts about Belize2.

Accident Insurance in Belize – Overview

3.

Qualifying conditions4.

Coverage

5.

Prevention Strategies6.

Limitations

7.

Recommendations8.

What we have

9.

What we need

2

3

Quick facts about Belize

•

Population: approx. 310,000 people•

Size: 8866 sq. miles or 22,963 sq. km.

•

Belize is both Caribbean and Central American•

Multi‐ethnic

•

Climate : Sub‐Tropical (55F or 12C to 100F or 36C)•

Government: Parliamentary Democracy

•

Language: Official –

English over 50% speak Spanish•

Largest unbroken; second largest unbroken barrier reef

in the world.

World Map

4

5

Map of Belize

6

Accident Insurance

•

All Belizeans have the option to purchase private insurance

•

Private insurance companies do not cover work‐ related accidents

•

Social Security covers all registered workers for accidents that occur on the job

•

In most case this amounts to 100% coverage in both private and public medical institutions after the

claim is allowed

Who qualifies for on‐the‐job Accident Insurance?

•

Any registered person from age 14 (this is the age a person can legally join the workforce in Belize)

•

Both employed and self‐employed persons

7

What are the conditions to qualify?

•

Be registered with Social Security

•

Employers are legally bound to hire only registered workers and pay contributions on their behalf (Not so

with self‐employed – voluntary)

•

Person has to have been injured during

and in the course of insurable employment

•

Qualifies as of Day 1

8

Coverage

All Medical care recommended by treating Doctor until person can return to work including:

•Hospitalization•Pharmaceuticals•Labs•Diagnostic testing •Rehabilitation (physical and psychological therapy)•Other medical needs such as wheelchairs, specialized

beds, walkers, etc.

9

Coverage cont’d

•

The injured person has the right to request a second opinion

•

While on leave from work the person is paid 80% of his insurable earnings

•

Every injured person is entitled to claim for Disablement benefit

10

Prevention Strategy

Some done by SSB as much as possible including:•Investigation and identification of hazards•Recommendations for recurrence•Documentation to Employers•Employer and Employee education on good

Occupational Safety and Health practices

11

Limitations

•

The OSH Legislation has yet to be passed by Cabinet•

SSB OSH Inspectors can make recommendations but

cannot enforce •

VERY little training and VERY little expertise in the

country•

SSB can educate the workers but cannot obligate them

to practice OSH•

SSB is bound by law to allow all claims whether or not it

was caused by employer or employee negligence •

There are no incentives for lowering the amount and/or

severity of work accidents (exception for those companies who have to meet international standards)

12

Recommendations

•

Organization and guidance of the NOSH/Working Committee

•

Aggressive lobbying by SSB for passage of the OSH Law•

Develop an incentive system to “award”

both workers

and employers who make efforts in OSH•

Training, training, training! Needed at all levels in the

area of OSH and accident prevention and investigation

13

What we have

•

Commitment – 10 years of writing and revising the present Legislation draft

•

Representation – Tri‐partite representation including workers’

unions on the NOSH/Working Committee

•

Some expertise

•

Some support from CARICOM and other international groups

14

What we need

Training at ALL levels including: •Medical – Eg. Occupational medicine (presently GP’s and other general

Specialists diagnose Occupational illnesses) •Inspectorate •Management

OSH Information System

Expertise in utilizing the available information to develop Accident Prevention in Belize

Consultancies to assist with the organization of National Committees

15

What does Belize have to offer you?

•

Most beautiful place on earth

•

Belize has a very functional National Health Insurance system still in its pilot phase instrumental in ensuring

better primary health care (also under Social Security)

16

Why should you come to Belize?

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

Thank you and see you soon!

33

34

PREVENTION OF WORK-RELATED MSDS – THE BENEFIT OF INTERNATIONAL COOPERATIONS

Dr. Rolf Ellegast

Institute for Occupational Health and Safety of the German Social Accident Insurance (IFA), Sankt Augustin, Germany

Musculoskeletal disorders (MSDs) are frequently described as a "national disease", since one person in two complains of problems in this comprehensive and complex area. MSDs are of immense importance in the occupational sphere. In Germany and many countries in Europe work-related musculoskeletal disorders are those causing the highest direct costs (costs of treatment) and indirect costs (loss of production owing to sick leaves), and for many years have led the statistics for working days lost owing to incapacity for work broken down by diagnostic group.

International cooperations of accident insurances can help to find preventive measures to tackle work-related MSDs. The presentation will give examples of

common strategies to prevent occupational diseases, joint research programs and technical developments and cooperation approaches to cope with new emerging risks.

1

Prevention of work-related MSDs –The benefit of international cooperations

Dr. Rolf Ellegast

IFA – Institute for Occupational Health and Safety of theGerman Social Accident Insurance, Germany

Outline

� Introduction: Work-related MSDs in Europe and German y

� International cooperation on work-related MSD preve ntion

� Common strategies to prevent occupational diseases

� Joint research programs and technical developments

� Coping with new emerging risks

� Conclusions

� Benefits of international cooperation on MSD prevention

� Future offers and needs

2

Work-related MSDs in Europe

• Work-related MSDs represent the main occupational disease category in the EU.

• 1/3 of all European workers suffer from work-related MSDs.*

• Exposures to physical hazards have not changed since 10 years:**• 1/3 of EU workers are carrying heavy

loads• 23 % of EU workers are exposed to

vibrations

• 46 % of EU workers are working in awkward postures

*European Foundation for the Improvement of Living and Working Conditions (EFILWC, 2008).**5th European Working Conditions Survey (EWCS, 2011)

Work-related MSDs in Germany

• Approx. 24 % of all sick leave due to MSDs*

• Approx. 26.000 new invalidity pensions due to MSDs*

• Costs of loss of production -caused by MSDs - are estimated to be 9.5 Bn €*

→ MSD prevention is one of the OSH objectives in the „Common German Occupational Safety and Health Strategy“ – „GDA“

→ DGUV prevention campaign on MSD in 2013

*German OSH Report 2008

3

MSDs as occupational diseases in Germany

• Upper limb:• Diseases due to overstraining tendon

sheaths, peritendineum or muscular and tendonous insertions (2101)

• Osteoarticular diseases of the hands and wrists caused by mechanical vibration (2103)

• Carpal Tunnel Syndrome CTS (21XX)

• Spine:• Intervertebral disc-based diseases of the

lumbar or cervical spine (2108, 2109, 2110)

• Lower limb:• Meniscus lesions (2102 )• Knee osteoarthritis (2112)

International cooperation on work-relatedMSD prevention

Common strategies to prevent occupational diseases

•CTS was introduced as occupational disease in Columbia since several years.

• 45 % of all MSDs are due to CTS.• Experiences with associated risk factors and affected professions/tasks exist.

• Ongoing prevention activities in Colombian companies

4



•Cooperation project in the Colombian Floriculture Sector with

• > 90.000 employees in the Colombian Floricultural sector

• Ergonomic intervention study to improve workplaces and the understanding of CTS risk factors

• Application of common risk assessment tools, e. g. CUELA measurements

→ Presentation of Yanet Zapata Tamayo



•Future aim: Development of common international exposure data bases

• Cooperation with Lund University Hospital, Sweden

• Similar structure of risk factors and associated tasks

• Interfaces to other MSD exposure databases, e. g. vibrations, spinal loads

CTS Database

5



•Spinal workloads: cooperation with Canadian accident insurances, IRSST, Montreal, Quebec

•Project “911”: Assessment of spinal exposures of emergency medical assistants

•Application of common risk assessment tools, e. g. CUELA measurements

• Development of preventive measures


Joint research programs and technical developments

• International cooperation with accident insurances and university institutes to develop biomechanical models within joint research

• Aim: Calculation of internal muskuloskeletal loads during the performance of work tasks

• On basis of the results better task specific prevention measures can be derived

6



•Development and calibration of measurement systems for long-term physical exposure assessment

•Cooperation with Canadian University of Sherbrooke und IRSST

• Aim: quality control of ergonomic workplace assessments



•Technical developments to tackle combined physical risks

•Cooperation with Loughborough University and INRS in France to develop and test a measuring system for combined assessment of whole body vibration and awkward postures

• Use of research results in international standardization

7


Coping with new emerging risks•Example: prevention of underload at physical inactive workplaces


Coping with new emerging risks

• Increase of inactive lifestyle, 58 % of the population of industrialized countries is regulary physical inactive (WHO, 2002)

• More than 60 % of all employees in Germany are working mainly in sedentary postures (BAuA, 2008)

• Prolonged physical inactivity leads to negative effects on the musculoskeletal and cardiovascular system

8


Coping with new emerging risks

• Cooperation with the Dutch TNO Institute for Work and Employment

•Development of new dynamic office concepts addressing the physical activity of office workers

•Evaluation of dynamic concepts regarding the increase of physical activity and energy consumption

• Derivation of recommendations for companies


Benefits of international cooperation on MSD prevention

• Accident insurance systems participate from the synergetic effect in

• international exchange of experiences to prevent occupational diseases

• joint research programs and technical developments

• finding collective preventive measures for new emerging risks

•Avoidance of redundant work

•Common international cooperation leads to widespread and powerful prevention strategies

• Intercultural exchange

9


Future offers and needs

• Invitation to accident insurers to

• share our national knowledge on MSD prevention and occupational diseases

• use common exposure databases and technical equipment

• Need in exchange of experiences in

• coping with new occupational diseases, e.g. lower limb disorders

• conducting a prevention campaign on MSD/LBP

THANK YOU for your attention !

Further information:

www.dguv.de/ifawww.dguv.de/d/ifa/fac/ergonomie/index.html

Contact details:Dr. Rolf EllegastInstitute for Occupational Health and Safety ofthe German Social Accident Insuarance – IFAAlte Heerstraße 111, 53757 Sankt Augustin, Germany www.dguv/ifa.de [email protected]: 02241-231-2605 Fax: 02241-231-2234

EUROPEAN FORUM Dresde - 21-22 juin 2011 Speaker : Raphaël HAEFLINGER, EUROGIP

Name: Raphaël HAEFLINGER

Name of Organisation: EUROGIP

Title of Presentation: Échange de connaissances et d'expertises sur les risques professionnels en Europe : l'expérience d’EUROGIP

The presentation will be given in French

No Power Point Presentation Abstract Échange de connaissances et d'expertises sur les risques professionnels en Europe : l'expérience d’EUROGIP La coopération européenne est à la base même de la mission d'EUROGIP depuis sa création en 1991. Les formes de coopération sont variées : bilatérale sur des sujets spécifiques ou multilatérale à travers le Forum européen par exemple. EUROGIP agit selon ces deux approches, complémentaires, qu'il privilégie en fonction des objectifs poursuivis. À travers différents exemples seront présentées les principales activités d’EUROGIP dans le domaine de l’assurance AT/MP qui mettent en œuvre des coopérations avec d’autres pays ou organismes. En termes de bilan, l’échange de connaissances et d’expériences sur l’assurance AT/MP se révèle indispensable dans un processus de convergence des différents systèmes et approches assurancielles. Malgré les nombreuses différences selon les pays, des problématiques d’intérêt commun existent en Europe et au-delà, sur divers aspects (juridique, statistiques, prévention…). Si la multiplication des lieux et des niveaux d’échanges est indispensable, il serait indéniablement utile d’optimiser la mise à disposition et la circulation des connaissances existantes.

EUROGIP EUROGIP est un groupement d'intérêt public (GIP) constitué en 1991 par la Caisse nationale de l'assurance maladie des travailleurs salariés (CNAMTS) et l’Institut national de recherche et de sécurité (INRS). Ses activités se concentrent sur les aspects européens des accidents du travail et des maladies professionnelles (AT-MP). À ce titre, EUROGIP :

réalise des enquêtes comparatives sur les risques professionnels en Europe ;

publie des lettres d'information électroniques, des rapports d’enquêtes, des notes thématiques... ;

organise des conférences, les Débats d’EUROGIP, sur des thématiques européennes de sécurité et santé au travail ;

participe à des projets d’intérêt communautaire ;

coordonne un réseau d’experts (Branche AT-MP) qui participent à l’élaboration des normes européennes et internationales ;

assure le secrétariat des Coordinations françaises des organismes notifiés pour la certification réglementaire des équipements de protection individuelle et des machines (par délégation des ministères chargés du Travail et de l’Agriculture) ainsi que le secrétariat technique de la Coordination européenne "Machines" (contrat avec la Commission européenne).

Facing Future Challenges in Workers’ Compensation: Private

Insurance– the US ExampleGregory Krohm

Executive DirectorInternational Association of Industrial Accident Boards and Commissions (IAIABC)

Conference of the European Forum Dresden, GermanyJune 21-22, 2011

US Private Insurance

• History of development• Strengths • Weakness• Applicability of the US model elsewhere

Development

• From its advent in 1911, private funding of benefits was the norm for the US workers’ comp system– Only six states established single payer

government funds• Private WC insurance became a highly

standardized/uniform across states– Much different than other property/liability

insurance in the US

How Did Standards Develop?

• Private insurance in the US has similarity and uniformity in:– Insurance agreements– Rate classifications– Rate making methods– Experience rating– Reporting of claims and premium– Reporting proof of coverage to regulators

• This uniformity is largely due to the establishment of a national statistical agent/rate making organization

NCCI: statistical agent & rate maker

• The National Council on Compensation Insurance (NCCI) was founded in 1922

• From its founding the NCCI worked with insurance regulators for approval business practices:– The insurance agreement– How class and individual experience rates would be

set– Rules for auditing premium and other adjustments to

the insurance contract• Originally served 10 states; now working in 40

states

Strengths

• Less political involvement in administration, particularly rate making

• Strong solvency standards– No deficits or liability to general public

• Guaranty funds pay insurance benefits of insolvent insurers and spread the cost to other insurers

• Wide range of choice of carriers– Carriers differ somewhat on rate levels,

underwriting, and policyholder service

Weaknesses

• High administrative expense– Profit, marketing, and agent commission

• Insurance rating cycle– Seemingly irrational ups and downs in pricing

• No strong commitment to safety and loss control

• Mixed performance on rehabilitation and return to work

Downside of Competition

• Competitive insurance defeats the goal of universal coverage– Very high risk employers will not be able to find

coverage, or only at “excessive” rates • In the US, the solution to lack of availability is

a government mandated market of last resort– Assigned risk plan– Risk pool

• Aggressive competition also leads to unsustainable price cutting

Applicability

• Worldwide, there seems to be a very slow expansion of private insurance as the funding source for WC benefits

• In the US, the move to private insurance seems to be as a reprisal for a public system that has failed to meet stakeholder expectations or has run up large deficits

Applicability

• The US system cannot be fully imitated because it requires a very expensive infrastructure– Rating/statistical agencies need to be

authorized, regulated and funded– If more than one rating agency is to exist, there

must be close coordination

Other Barriers to Applicability

• US system is distributed by professional insurance agents, which may not be available

• Private carriers in the US are closely regulated by:– State insurance departments (solvency)– State industrial commissions (benefit payments)

Summary

• Private insurance in the US is strongly entrenched as the delivery and financing system for WC

• Private insurance seems to cost more than publicly funded systems

• Unfunded deficits and administrative breakdowns are less widespread among private insurers– Unsuccessful insurers disappear from the market

• US model is not readily applicable elsewhere

Questions

Questions can be directed to the author at:[email protected]

About the IAIBC The IAIABC is a not-for-profit association that represents government agencies charged with the administration of workers’ compensation programs. There are more than 60 jurisdictional members, primarily in the US and Canada. The IAIABC engages in research and educational programs for its members. Contact information: International Association of Industrial Accident Boards and Commissions 5610 Medical Circle, Suite 24 Madison, WI 53719 608-663-6355 email: [email protected] Web: www.iaiabc.org

mailto:[email protected]

http://www.iaiabc.org/

Neither public nor private: Self- insurance in workers

compensationAlan McClain

Outline

• General concept of “self insurance”• Benefits of self insurance• Core regulatory features in the US• Variations on US model in Canada and

Australia

General Concept of Self Insurance

• Not really “insurance” because there is no spreading of risk over a pool of entities

• In reality this is self funding of benefits• Must be selective approval to self fund

– Risk of default on payment can be very high

Benefits

• Companies want to self insure for a variety of reasons

• Dissatisfaction with private insurers– Pricing, service, etc

• Belief that an actuarilly fair rate would overcharge them because of their better loss experience

• More control over claim handling

US Self Insurance

• All but two states allow self insurance• Requirements are generally more liberal

for government entities• The typical state may have 200 or so self

insured employers• Group self insurance is allowed in 26

states

Core Regulatory Feature in US

• Screening mechanism for would-be self insured employers

• Setting financing security levels as a backstop against default

• Reviewing periodic financial/operating reports for licensed self insurers

• Curtailing right to self insurer is standards are not met

• Dealing with bankruptcy of self insured

Variations: Canada

• Self insurance in Canada is much less common than in the US

• Governments of Canada and individual province/territory are self insured

• Several provinces do not allow non government self insurance

Australia: General

• Six states (New SouthWales, Queensland, South Australia, Tasmania, Victoria andWestern Australia)

• Two territories (Australian Capital Territory and Northern Territory).

Variations: Australia

• Self-Insurance is permitted in all 6 states• Subject to state specific requirements

Australia: Common Requirements

• Financial Capability• Health & Safety Provisions• Return To Work Emphasis• Capacity to administer claims process

Federal Government Self Funding

• Compulsory workers' compensation program for employees of the commonwealth - Australian federal government and national agencies

• Central fund, but both self insurance and self administration is permitted.

QUESTIONS?

1 Director Ejecutivo OISS

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Perfil diferencial

17,5 millones de niños trabajan y 22.000 mueren anualmente.

50% trabajadores informales (+120 m).1

Otros Colectivos desfavorecidos: mujeres, migrantes, indígenas …

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Intensidad del

fenómeno

Subregistro de AT (20%) y de EP (1-5%).

30 millones AT y 240.000 muertes relacionadas con el trabajo.

Construcción, agricultura y minería: 140.000 muertes

La siniestralidad compromete el 10% del PIB de la Región.

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Diagnóstico de la Región Iberoamericana:

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Adaptada a realidad Posibilista Consensuada

Proceso de elaboración:

Encomienda a la OISS Ministros y Máximas Autoridades

Respaldo Máximas Autoridades:

VII Conferencia Ministros y Máximos responsables de Seguridad Social

XIX Cumbre Iberoamericana de Jefes de Estado y de Gobierno

Aprobación definitiva: Declaración de Santiago

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Aborda objetivos concretos y posibilistas, estableciendo diferentes niveles de intervención que han de plasmarse en Estrategias Nacionales.

Características de la Estrategia:

Se configura como un documento dinámico, no reactivo.

Pretende diseñar un marco común y compartido.

Estructura:Diagnóstico (mercado laboral, siniestralidad, protección social).

5 objetivos generales: principios programáticos.

8 objetivos específicos: en niveles adaptables.

Plan de Acción y seguimiento.

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Concebidos como principios programáticos o rectores de las políticas de seguridad y salud en la Región

Avanzar en la mejora de las condiciones de trabajo en la Región. .

Objetivos Generales

Avanzar en el protagonismo de los agentes sociales en el establecimiento de Políticas públicas de Seguridad y Salud.

Lucha contra el Dumping social.

Generar mejoras efectivas en la cultura preventiva.

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Mejorar los sistemas de información y registro de accidentes y enfermedades profesionales. Homogeneidad y elaboración estadísticas. Creación del Observatorio de Riesgos profesionales.

Incrementar la cooperación y colaboración regional en la materia:

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Incluyen acciones concretas y un planteamiento de seguimiento y evaluación a través de indicadores.

Se diferencian los Estados en función del desarrollo de su estructura preventiva.

Objetivos Específicos

Reforzar el marco normativo de cada Estado.

Conocer situación nacional. Diagnóstico situacional. Encuestas de condiciones de trabajo.

Reforzar los Órganos Técnicos de Seguridad y Salud.

Reforzar las instituciones nacionales de Inspección y Control.

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Avanzar en investigación y estudio de la multicausalidad.

Promover programas de apoyo en PYMES y autónomos.

Mejorar capacitación de agentes implicados.

Promoción de Políticas Públicas de Responsabilidad Social.

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Informes específicos (Disponibles 9: Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panamá, Chile, Ecuador y Colombia. (Apoyo en la red SALTRA)

Ultimado y validado cuestionario de encuesta de condiciones de trabajo. Previsión primera aplicación en Centroamérica en el 2º semestre de 2011.

Informe actividades realizadas:

Análisis de situación de las condiciones de trabajo y las políticas de seguridad y salud

Constitución Cátedra de salud laboral: J. Andalucía/Univ. Almería

Asistencia técnica a países:Presencial: Gobierno de Chile, CODELCO, Argentina,

Remota (on line): Compromiso respuesta técnica en 72 horas. Web OISS - Serviprevencia

Sensibilización y formación: cursos cortos, divulgación…

Investigacion: Estudio trabajo infancia y mujeres

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Acuerdo tripartito de apoyo a la EISSTDeclaración de Granada: especial referencia al escenario

económico y las políticas de seguridad y saludDeclaración de GranadaFINAL.doc


IV Congreso Iberoamericano de Prevención de Riesgos laborales en Iberoamérica PREVENCIA 2010:

Observatorio de Seguridad y Salud:

Estrategias / Planes Nacionales de concreción de objetivos:

Argentina (firmado), Chile (Comisión de Gobierno), Colombia (PNSO 2010-2012), España y Portugal (U.E.) en tramite C. Rica, Panamá, Dominicana, Salvador y Guatemala.

•Ultimado soporte informático y estructura

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OIT/CSA: Formación representantes de los trabajadores, Argentina (febrero/marzo 2011)

UGT-España/Universidad de Uruguay: formación y apoyo al desarrollo de encuesta de condiciones de trabajo .

Mutuas Españolas: 6 trabajos de investigación. INSHT España: entrega de materiales de autoevaluación

de riesgos, estudios técnicos, material didáctico.RED SALTRA, U. Pompeu Fabra, ISTAS-CCOO España


Programas de trabajo en colaboración:

Disponible plataforma on line y programas comprometidos con agentes sociales: prevención básica, dialogo social, relaciones laborales

Máster superior tres especialidades. Multitud de Materiales autodidácticos: formación, fichas técnicas,

autoevaluación de riesgos, soportes especiales PYMES, recomendaciones preventivas sectoriales, actividades sensibles…

Formación / divulgación: www.oiss.org /EISST/Serviprevencia

http://www.oiss.org/

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…les esperamos en Cartagena de Indias el próximo 29 de junio

Gracias por su atención y….

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CONSIDERANDO

3.Que en el presente Congreso se ha puesto de manifiesto el riesgo de que los ciclos económicos bajos y, en particular, la situación de crisis mundial que se vive en la actualidad, incidan en el deterioro de las condiciones de trabajo y en el incremento del empleo informal, en la recesión de las inversiones en medios preventivos y en el estancamiento del desarrollo de políticas de Seguridad y Salud laborales.

4.Que dicho proceso vendría a incrementar los ya elevados ratios de siniestralidad de la Región y agravar los efectos perniciosos sobre las personas en términos de salud, discapacidad y muerte.

DECLARACIÓN PREVENCIA 2010En Granada (España) a veintiuno de mayo de 2010, en el seno del

IV Congreso de Prevención de Riesgos Laborales en Iberoamérica “PREVENCIA 2010”, los participantes en el mismo, ………

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DECLARAQUINTO:El Congreso expresa su convicción de que el desarrollo de políticas de Seguridad y Salud, lejos de ser un obstáculo a los procesos de reactivación económica, coadyuvan al incremento de la productividad y la competitividad y reducen, de manera trascendente, los costes derivados de la siniestralidad laboral y la enfermedad profesional, así como los daños a la salud y a la vida de los trabajadores.Por ello, es preciso tomar conciencia y evitar el riesgo de recesión de las inversiones en Seguridad y Salud en los periodos más bajos del ciclo económico.

Director Ejecutivo OISS

Diagnosis of the Latin-American Region:

30 million Accident at Work and 240.000 fatalities related to work.

Subregistration of Accident at Work (20%) and of Occupational Disease (1-5%).

Construction, agriculture y mining: 140.000 fatalities

Iberoamerican Strategy

Production Process:


Characteristics of the Strategy


It sets specific and achievable targets, establishing different levels of intervention

General Objectives


Knowledge of the National Situation. Situational diagnosis. Working conditions Surveys.


Promote supporting programs in PYMES and Autónomos (Small bussiness And Self-employed).

Situational analysis of working conditions and health and safety policies

Creation of the Department of Occupational Health: University of Almería (Spain)

Technical assistance to other countries(onsite and remote/on line)

Training and Awareness: ( www.oiss.org/EISST/Servipreventia )

Iberoamerican Congress of occupational risk prevention: PREVENCIA 2010

National Plans to consolidate goals

Work programs in collaboration with other organizations:

Activity Report:


http://www.oiss.org/EISST/Servipreventia

Thanks

Abstract of the Presentation: International Co-operation in OHS – Impacts, Sustainabiliy and Challenges Holger Trechow, Head of Section OHS, GVG – Gesellschaft für Versicherungswissenschaft und -gestaltung GVG comprises the key actors of the German Social Security System. In its national and international work, GVG covers all the five branches of social insurance. In its international project work, GVG works closely with and largely relies on the DGUV and the BG system at large, as well as on the state authorities for occupational health and safety. Projects in OHS funded by the EU, World Bank or other Donors, as well as Study Projects (e.g. funded by DG EMPL) on a variety of Health and Safety related topics are to a large extent donor-driven. The designing phase of such projects is highly important as it defines the objectives and mandatory results based on an outline of the project activities. The example of Turkey, at least at a first glance, may highlight how international co-operation may support the long-term process of establishing a national safety culture. But is continuity between the different development stages ensured both in the national process and in Technical Assistance? Further examples will be provided to critically discuss the impact of international co-operation, its shortcomings and challenges. Resuming, it can be stated that international co-operation in Technical Assistance projects and beyond does not only provide an arena for various forms of exchange and a strong impetus for the harmonisation of social security in the world of labour, but it is an important tool to support the safeguarding of the workforce from any threats to their health and safety.

GVG – Short Portrait The GVG’s international activities are an extension of our contribution to the social policy discussion in Germany. Conferences and workshops offer our partners both inside and outside the European Union a forum for exchanging ideas and sharing experience within the context of the international social policy debate. On behalf of German and foreign Ministries and International Organisations, we advise Governments, Social Security Institutions and other Clients on social security issues. Our projects provide support at various levels. We offer consultation on reorientation and restructuring processes in the social security sector, we give practical support in the drafting of legislation, we provide longer-term consultation and support for the administrative reorganisation of social security systems and institution building and we design training courses for specialist staff. The assessment and evaluation of social policy measures is also part of our work.

GVG e.V. - Hansaring 43 - 50670 Köln

www.gvg.org

EUROPEAN FORUM - Adding Value through

International Cooperation

Conference, Dresden

June 21 to 22, 2011

International Co-operation on OHS -Impacts, Sustainability and Problems

Perceived


www.gvg.org

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Speaker

Holger Trechow

Head of Section OHS / Project Manager eHealth

M.A. Political Sciences (Cologne)

Master in Humanitarian Assistance (Bochum / Uppsala)

Working e.g. for CARE (in BiH), BMZ, gtz/giz in the areas of Social Security Policy / Poverty Reduction

Kontakt: [email protected]


www.gvg.org

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GVG Members

GVGHealth Care Providers

Associations of: Doctors / Dentists / Physiotherapists

Hospitals / Rehab ClinicsIndustry (Pharma, Med. Aids)

Social PartnersEmployers‘ Organizations

Trade Unions

Scienceand

Research

Companypension and health

schemes

StatutoryInsurances

Pension / Health /Long-Term Care / Accident

Private InsurancesLife / Health /

Long-Term Care /Accident


www.gvg.org

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Mandate: Maintain and strengthen the basic consensus on the fundamental principles of the German social security system:

- Solidarity: Provide society‘s support to individuals in need

- Subsidiarity: bottom-up approach – first, the lower or more immediate level shall deal with matters in their area; higher levels get involved only in case of need

- Enforce individual risk coping (problem solving) capacities

- Diversity: Ensure a pluralistic system with a variety of institutions to take care of the specific needs of diverse population groups

- Ensure access of all members of society to a liberal and pluralistic system of social security and a broad scope of high-quality coverage for the major risks in life

- Based on the principle of self-government

Basis of our national Work


www.gvg.org

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International consultancy answering the large need in Eastern European Countries

Basic requirement: modernise the OHS systems and adaptthem to EU / ILO requirements

Focus of international OHS projects clearly on prevention!

Close co-operation with DGUV and German State and Federal State Authorities

Only one project on the Accident Insurance System (Ukraine, EuropeAid114778: Support to the Development of the Accident Insurance system in Ukraine)

What do we do internationally?


www.gvg.org

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In the following slides, some examples of our work are presented:

- To give an outline of possible interventions

- To demonstrate the variety of (also high orlow) impacts of international co-operation

- To show some problems that may befaced in this field of work

What do we do internationally?


www.gvg.org

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Basic project interventions:

• OHS Policy / Strategy

• Capacities

• Training

• Social Dialogue

• Setting up institutions / infrastructure (e.g. OHS

Centre, OHS Laboratory)

Five basic interventions


www.gvg.org

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A – Turkey

Turkey 1: large-scale TA (Technical Assistance) project2004-2006 with DGOHS on policies, strategies, capacitybuilding / training, public awareness + OHS laboratory

Turkey 2: Twinning Project with LIB (Labour InspectionBoard) providing training in key risk areas (2008-09)

Ongoing:

Turkey 3: (but not implemented by GVG): introduction of pilot OHS management systems at enterprise level, parallel OHS Lab project (start 2010)

Turkey 4: PPE lab for market surveillance (start 2011)

Turkey 5: SEVESO II (still in forecast) …

Exemplary projects I


www.gvg.org

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B – Others

Azerbaijan 1: Worldbank (WB) project on Enhancing State Labour Inspectorat Service (SLIS) Capacities (2010–13)

Azerbaijan 2: EU Twinning on Support to SLIS for OHS Enhancement (2011-12)

Russian Federation: EU - TA on Approximation of OHS Legislation (2006-07)

Latvia: EU Twinning Occupational Health and Safety system (with Labour Inspectorate, 2006-07)

Ukraine: EU TA Support to Development of the Accident Insurance System (2004-05)

Exemplary projects II


www.gvg.org

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Key features of work on projects

1) Design by the Beneficiary and Donor is very important

2) Continuity: how are project results taken on board and furtherelaborated

3) Political support: a strategy may be developed as an instrument to achieve ownership at all levels

4) Training: is it enough to evaluate training sessions? How cantrainings (mainly for state officials) be improved

5) Exchange: - between experts

- at enterprise level

- on methodologies (training, awarenessraising etc.)

OHS projects - Assessment


www.gvg.org

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Worldbank

- Macedonia: Feasibility study on strengthening

enforcement capacity of the state labour inspectorate

DG EMPL

- Proposal for commission practical guidelines for training

of workers involved in work with asbestos (2009-10)

- Impact on OHS in EU of the increasing use of portable

computing and communications devices (2009-10)

- Report on ... OD systems in EU Member States …, in

particular relative to Recommendation 2003/670/EC concerning European Schedule of OD (start 2011)

Exemplary studies


www.gvg.org

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Key features of work on studies:

1) Contribution to health and safety of the workforce and the population (e.g. asbestos)

2) Harmonisation process with EU and international standards (Macedonia)

3) International institutional co-operation4) Preparation of political decisions at EU level

5) Topics with potentially strong political impact6) Are interventions well-targeted? Asbestos Guidelines

vs. Standards e.g. regarding demolition works(asbestos roofs etc.)

OHS studies: Assessment


www.gvg.org

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International Co-operation:

- Paves the way for economic co-operation

- Helps harmonise the social security systems

(core labour standards, access to markets,

competitiveness)

- Provides exchange of experts at even level

- Helps to reflect the own system

- Supports the safeguarding of the workforce!

Resume and Outlook

Issue 04 Future challenges in workers’ compensation

A discussion paper by the Munich Re Centre of Competence for Workers’ Compensation

Issue 04

Contents

Executive summaryWorkers’ compensation at a crossroads

Workers’ compensation insuranceA pillar of social and fi nancial security

Future challengesIs today’s system fi t for tomorrow’s working world?

ConclusionsAwareness, dialogue and cooperation are called for

References

The Munich Re Group operates worldwide, turning risk into value. In the fi nancial year 2008, it achieved a profi t of €1,528m on premium income of around €38bn. The Group operates in all lines of business, with around 44,000 employees at over 50 locations throughout the world and is character-ised by particularly pronounced diversifi cation, client focus and earnings stability. With premium income of around €22bn from reinsurance alone, it is one of the world‘s leading reinsurers.

About the Centre of Competence for Workers’ CompensationActing on its keen awareness of the special role – and global importance – of workers’ compensation insurance, the Munich Re Group established the Centre of Competence for Workers’ Compensation in 1998. Since then, the highly specialised and dedicated team of experts has been monitoring and analysing developments in this complex type of social insurance on a world-wide scale. Today, the Centre of Competence is an internationally valued and respected source of advice and information regarding systems with state and/or private-sector involvement.

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1Munich Re Future challenges in workers‘ compensation

Dear Reader,

The Munich Re Centre of Competence for Workers’ Compensation has been closely monitoring international developments in this extremely complex area of risk man-agement for more than ten years. In addition, we have been listening to the views and experiences of diverse stakeholders from all over the world. One of the main con-clusions we have reached as a result of our research and knowledge-gathering can be summed up as follows: the demands on workers’ compensation are changing.

Due to its key role in society, workers’ compensation is far too important to be put at risk. And the only way to guar-antee that it remains fi t for the future is through an open exchange of views among all involved parties. This is why we have compiled some thought-provoking information on future challenges. By no means comprehensive or conclusive, the brief overview in the following pages is designed to offer insights and foster discussion.

Regardless of your personal level of direct or indirect involvement in workers’ compensation, your thoughts are important – and you can make a valuable contribution. We wish you interesting and informative reading.

With best regards,

Victor Schultheiss Head of Centre of Competencefor Workers’ Compensation

2 Munich Re Future challenges in workers‘ compensation

Executive summary Workers’ compensation at a crossroads

All over the world, workers’ compensation systems face new challenges – with more looming on the horizon. The Munich Re Centre of Competence for Workers’ Compensation has gath-ered information on a number of issues with possible repercus-sions for this important form of social insurance.

The main challenges are identifi ed as follows (listed alphabet-ically): chronic diseases, climate change, demographic shift (greying workforce), legal confl ict, migration, musculoskeletal disorders, obesity, psychological disorders, use and abuse of prescription drugs. Each of the factors – individually and/or in combination with others – could potentially put signifi cant pres-sure on a workers’ compensation system. For the sake of brevity and clarity, this paper looks at four examples that underscore the importance of closely monitoring these developments.

Climate Global climate change is now widely accepted as scientifi c fact. Rising water levels are already rendering some coastal and island regions uninhabitable, triggering migration. Experts fore-cast an increase in the frequency and/or intensity of heat waves and droughts in southern regions and milder winters with more precipitation in northern geographies. The probable impacts on occupational disease include increased risk of heat-related dis-orders, respiratory disease due to pollens and cancers caused by ultraviolet radiation.

Demographics Higher life expectancies and the increasing average age in most countries suggest that tomorrow’s workforces will contain a bigger share of older employees. A greying future workforce will be more prone to accidents and diseases associated with ageing. In addition, more long-latency illnesses must be expected.


Drugs More and more professionals use prescription drugs to boost performance. Taking any medication for a purpose other than that for which it has been approved is inherently risky, and many such stimulants and antidepressants have lists of known side effects, including addiction. Some amphetamine-based drugs, designed to treat attention-defi cit hyperactivity disorder (ADHD), are already in use as cognitive enhancers in signifi cant numbers. And a new generation of pharmaceuticals aimed at treating cognitive decline – with considerable potential as so-called neuroenhancers – is emerging. Workers who over-estimate capabilities, become euphoric and lose sleep could represent a higher accident risk.

Obesity Obesity, defi ned as a body mass index (BMI) of more than 30, is already considered a global epidemic – and it continues to increase. Excessive body fat is linked not only to a large number of common health problems, but also to occupational accidents and diseases. Signifi cantly overweight employees have been shown to suffer more on-the-job accidents.

What this means for workers’ compensation These changes are real. Precisely how they will unfold and inter-act to compound one another is impossible to forecast. Very probable results include sharp increases in the complexity of attributing disorders to occupational causes as well as in the frequency of litigation. For this reason, risk carriers and policy-makers must be prepared to take steps to stabilise the delicate balance between the four basic components of social insurance – defi nitions, benefi ts, coverage, fi nancing. The shifting risk landscape and what it means for the defi nition of events that trigger claims (triggers) and premiums must be closely moni-tored. All workers’ compensation systems are well advised to subject current reserves – notably IBNR (incurred but not reported) and IBNER (incurred but not enough reserved) – to a stress test in order to determine whether they are suffi cient to meet the challenges ahead. A very close look at the logic used to defi ne premiums (loadings) might be useful. The categorical pricing approach used in many countries might not be valid in tomorrow’s world. At the same time, it should be noted that the world’s workers’ compensation systems have overcome many obstacles over the past 125 years. Based on transparency, co-operation and dialogue, these future challenges can be mastered as well.

Executive summary


Since its inception in the late nineteenth century, workers’ compensation insurance has developed into one of the most important cornerstones of social justice and welfare.

Its immediate effect was to largely free workers and their fam-ilies of the often tortuous task of litigation against employers to gain compensation in the event of occupational disease or acci-dent. But it was also welcomed by many companies, which had previously faced court cases with uncertain outcomes. Workers’ compensation insurance required employees to forgo the right to sue for damages due to a covered claim. By providing a clear framework of covered risks and benefi ts in cash or in kind, work-ers’ compensation has served as a pillar of fi nancial security.

Today’s systems vary widely, with many countries maintaining public monopolistic programmes while others include private participation. The solutions also differ in terms of which risks are recognised as occupational. The laws governing attribution of disease or accident to work-related causes are anything but uniform. Carpal tunnel syndrome, which affects the wrist and hand, causing symptoms including numbness and a tingling or burning sensation, is one example of a disorder that is cat-egorically excluded in some countries and included in others – in some as an occupational accident while in others as an occu-pational disease. In other words, defi nitions are in fact a purely political matter.

Stakeholders throughout society But as multifaceted as the approaches to workers’ compensa-tion insurance are, all markets share a number of characteris-tics. They all involve a complex matrix of stakeholders (see Fig-ure 1, The stakeholder matrix): alongside the primarily affected parties – employer, employee and dependants, the state – the risks and benefi ts have direct or indirect bearing on many other elements. Customers and suppliers of employers, for example, would feel the consequences should a system fail to provide the necessary fi nancial stability and planning security to keep a company solvent. Without insurance, entire families would be at risk of having to compromise their lifestyles should bread-winners fall ill, which would in turn impact the communities in

Workers’ compensation insurance A pillar of social and fi nancial security

Defi nitions Benefi ts

Financing Coverage

Figure 2: Social insurance in balance

The four basic elements must be kept in perfect balance

Figure 1: The stakeholder matrix

State, employer, employees

and dependants

Workers‘ extended families

Local businesses

Public and private insurance carriers

National and international

social security organisations

(e.g. ISSA, EISS)

International organisations

(e.g. ILO, WHO, World Bank)

Suppliers

Occupational safety and health

organisations/institutions

Universities,research

institutions

Investors

Employers‘ cus-tomers

All systems have one thing in common: a complex matrix of stakeholders


which they live. The resilience and effectiveness of a state’s workers’ compensation insurance system is a key factor in the viability of its government and institutions. Arguably, workers’ compensation touches each and every member of society.

A further aspect common to all solutions concerns the basic mechanisms with which they function. These can be divided into four highly interconnected components: defi nition of occu-pational accidents and diseases (what is covered?); benefi ts provided in the event of a covered risk (compensation in cash or in kind?); coverage (which groups are covered?); and fi nancing (who pays how much and when?). These must be in balance at all times (see Figure 2, Social insurance in balance). As the four columns strongly interact with one another, any development in one area has consequences in others. A disproportionate bur-den can threaten the entire system.

Complex attribution Against this backdrop, it is extremely important to closely moni-tor trends in workers’ compensation insurance. Most experts agree that the foremost developments in past decades have been increases in hazards whose effects appear long after ex-posure (long-latency risks) as well as in diseases with multiple causes (multi-causality risks). These trends, coupled with changing working habits and new technologies in the work-place, have converged to make attribution more and more complex. In future, further increases in this complexity must be expected.

Workers‘ compensation insurance


When the world’s fi rst Workers’ Compensation Act was passed in 1884, it was designed to address the needs of companies and their employees in a society that had been radically reshaped by the industrial revolution. It provided a level of fi nancial security for workers in the event of occupational accidents and diseases, while at the same time largely protecting employers from lawsuits – up to then an employee’s only recourse to secure compensation in such cases.

The occupational hazards in workplaces of the period were clearly defi ned. Today, the situation is quite different: although traditional risks like exposure to noise are still signifi cant, there is a clear trend toward multi-causal and less tangible risks. These include, for instance, ergonomic and organisational occu-pational hazards, notably those related to stress. The Munich Re Centre of Competence for Workers’ Compensation researches and maintains an ongoing dialogue on these factors with a broad spectrum of stakeholders. In order to establish a frame of reference for the defi nition and observation of globally relevant future challenges, the Centre of Competence has developed four key criteria for analysing developments:

Independent: Can it affect any workers‘ compensation system, independently of the way it operates (with or without competi-tion, public or with private participation, etc.)?

International: Can it affect any workers‘ compensation system, regardless of the country or territory in which the system oper-ates? Important: Is the expected impact in terms of frequency and severity suffi cient to warrant heightened awareness? Identifi able: Is there any evidence indicating that it could poten-tially impact workers‘ compensation systems?

Future challenges Is today’s system fi t for tomorrow’s working world?


Based on these “4 Is”, nine future challenges have been defi ned. These issues, which have been the subject of height-ened research and information-gathering efforts by the Centre of Competence over the past two years, are listed alphabetically below:

– Chronic diseases– Climate change– Demographic shift (greying workforce)– Legal confl ict– Migration – Musculoskeletal disorders – Obesity– Psychological disorders– Use and abuse of prescription drugs

In March 2009, the Centre of Competence hosted its fourth Workers’ Compensation Symposium, focusing on future chal-lenges. The gathering of international experts – including high-ranking representatives from research institutes and interna-tional organisations as well as decision-makers and researchers from various healthcare and insurance markets – confi rmed the relevance of the nine global issues defi ned above.

The nine factors can be expected to impact workers’ compensa-tion to varying degrees at different times. In some cases, with climate change for example, many potential effects can only be roughly estimated at this point. Interactions between the issues – such as how the increasing frequency of heat waves due to global climate change might affect the growing number of clinic-ally obese workers in many countries – represent an additional major variable. Together, the nine challenges may well compli-cate the attribution process and lead to increased litigation. To gain a better understanding of the current and emerging issues workers’ compensation systems will have to deal with in future, it is helpful to look at the most important challenges in more detail. Although all nine are signifi cant, below we have outlined four examples. These details underscore the impor-tance of heightened awareness.

Climate change The future repercussions of global climate change on workers’ compensation are diffi cult to judge. However, there is wide-spread agreement that climatic zones will shift, with conse-quences for vegetation, agriculture and fauna. In addition, the melting of glaciers – which can already be observed – is expected to result in fl ooding of coastal regions. And experts forecast an increase in the frequency and/or intensity of heat waves and droughts in southern regions and milder winters with more precipitation in northern geographies. The probable impacts on human health and thus on occupational accidents and diseases – at least as aggravating factors – are manifold (see Figure 3, Global climate change and its impacts).

Future challenges

An aggregate 1°C increase in monthly mean tempera-ture may increase total, respiratory and cardiovas-cular mortality by 1.4%, 10.4% and 1.6% respec-tively if the temperature exceeds the comfort range.W.J.M. Martens, Health Impacts of Climate Change and Ozone Depletion: An Ecoepide-miologic Modeling Approach

Observed data series Physical systems (snow, ice and frozen ground; hydrology; coastal processes) Biological systems (terrestrial, marine, and freshwater)

* Circles in Europe represent 1 to 7,500 data series

Temperature change °C1970-2004

-1.0 -0.2 0.2 1.0 2.0 3.5

Figure 3: Global climate change and its impacts

Europe * 1–30 31–100 101–800 801–1,200 1,201–7,500

Climate zones are shifting, with manifold impacts on health and safetySource: IPCC Climate Change


Hot weather There is evidence linking extreme heat episodes with increased illness and mortality. The heat wave in France in August 2003 caused more than 14,800 deaths. In some areas, excess mortal-ity rose to more than 100% in comparison to the previous three years. For outdoor workers, these risks might be considered occupational hazards. US statistics include employees in the construction, agriculture, forestry and fi shing sectors among those most exposed to the risk of heatstroke. In general, work-ing in hot environments diminishes mental performance (Ramsey, 1995) and increases accident risk (Ramsey et al., 1983).

Poor air quality Rising temperatures have also been associated with various negative effects on air quality. Pollens become more abundant, which in turn infl uences the incidence of allergic and respiratory diseases. And as the formation of ozone – a factor in respiratory diseases like asthma or chronic obstructive pulmonary disease – depends on sunlight, concentration is typically highest during the hot weather.

Ultraviolet radiation Experts say climate change also infl uences exposure to ultra-violet radiation (UVR), which is associated with higher rate of skin cancers and ophthalmic diseases.

Rising sea levels Many island and coastal populations have already been dis-placed due to rising sea levels. Experts also caution that “envir-onmental refugees” numbering hundreds of millions could be seeking to emigrate to more favourable climates in future, thus exacerbating a further complicating factor in workers’ compen-sation (migration).

Air pollution episodes are often linked to stationary or slowly migrating anti-cyclonic or high pressure systems, which reduce pol-lution dispersion and diffu-sion. Schichtel and Husar, 2001; Rao et al., 2003

In 2000, excessive UVR exposure is believed to have caused about 60,000 premature deaths. IPCC, Climate Change 2007

Rising sea levels affect around 19.2 million people. By 2010, the fi gure is expected to rise to about 50 million. The United Nations University, Institute for Environment and Human Security

Figure 4: Greying populations

Average age is increasing in most countries Source: UN Population Division (UNPD)

5.5

5.0

4.5

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5

0.0

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

15-59

0-14

60+

Bill

ion

s

Estimates Projections


Demographic shift (greying workforce) With life expectancies rising and people staying healthy later in life, it stands to reason that tomorrow’s workforces will include a larger proportion of older workers. A further, related, statistic that speaks for this development is the marked increase in the average age in most countries (see Figure 4, Greying popula-tions). Assuming the scenario of a greying future workforce, workers’ compensation and occupational health systems must prepare to accommodate a number of new or increased needs.

Injuries A statement by the UK Health and Safety Executive, corrobor-ated by statistics from Colombia and Argentina, says the rate of fatal injury among male workers increases with age. Companies will require special safety measures and employee training to keep their workforces healthy.

Complications The health risks that typically come with age, such as vision impairment, musculoskeletal disorders like lower back pain and psychological disorders like depression, require special consid-eration not only in terms of prevention, but also in case of reha-bilitation. In addition, they can act as complicating factors in the event of occupational accident or disease. As a result, more complex and costly medical treatment and long-term care must be expected.

Long latency By nature, long-latency disorders become more frequent with advanced age.

Average life expectancy of Europeans has increased by 28 years, from 45 to 73, over the past century. Professor Eino Heikkinen of the University of Jyväskylä in Finland

By 2050, 80% of all deaths in Europe are expected to occur in people older than 60. WHO

Future challenges

Figure 5: Weighing in on obesity

5 10 15 20 25 30 35 40%

Authorities consider obesity a global epidemic Population with BMI > 30 Source: Global Database on Body Mass Index World Health Organization

Saudi ArabiaUSAUnited KingdomMexicoNew ZealandChileSouth AfricaGermanyAustraliaPeruMoroccoCanadaFinlandColombiaSpainBelgiumBrazilSwedenPortugalSingaporeNorwayMalaysiaChina


Obesity Global authorities including the International Obesity Task Force and the World Health Organisation already consider obesity a global epidemic (see Figure 5, Weighing in on obesity). Defi ned as a body mass index (BMI) of more than 30 (see Figure 6, How BMI is calculated), obesity is widespread in many countries – and it continues to increase. Excessive body fat is linked not only to a large number of common health problems, but also to occupational accidents and diseases. Tackling the problem of obesity calls for heightened cooperation among employers, employees, risk carriers and regulatory bodies aimed at foster-ing awareness of healthier lifestyles and eating habits.

Accidents and diseases Signifi cantly obese workers have been shown to suffer more frequent and severe on-the-job accidents. A general lack of physical fi tness coupled with the increased strain that the excess weight places on the musculoskeletal system can cause and exacerbate accidents. At the same time, obese employees are believed to be more susceptible to some toxins, which are absorbed through the skin. And it has been argued that work-places and personal protective equipment are not adjusted to this specifi c working population. For example, protective suits and fall-arrest equipment are not designed for the extremely obese.

The next generation Studies in a number of countries point to alarming rates of obes-ity among children. That means future workforces are likely to be even heavier on average than those of today – and that the health issues associated with obesity will be with us for a long time.

Employees in obesity class III (BMI 40) had 11.65 claims per 100 full-time employ-ees, while recommended-weight employees had 5.80; the effect on lost workdays (183.63 vs. 14.19 lost work-days per 100 full-time employees), medical claims costs (US$ 51,091 vs. US$ 7,503 per 100 full-time employees ), and indemnity claims costs (US$ 59,178 vs. US$ 5,396 per 100 full-time employees) was even stronger. Archives of Internal Medicine, April 2007

In 2002, 30.3% of boys and 30.7% of girls in England were overweight; 16% were clinically obese. British Medical Association

In 2004, 31.1% of males and 33.2% of females over the age of 20 in the USA classi-fi ed as clinically obese. WHO

Figure 7: Global upswing in stimulant usage

19982008

10 30 40 50 60 70 80 90 100200

Prescriptions of methylphenidate-based stimulants increased tenfold between 2008 and 1998 to almost 46 million – illegal sales not included. Source: Wirtschaftswoche (a leading German fi nancial journal)

Principal cut-off pointsUnderweight < 18.50Normal range 18.50 - 24.99Overweight ≥ 25.00Obese ≥ 30.00

Body Mass Index is the most widely accepted gauge of obesitySource: adapted from WHO 2008

Figure 6: How BMI is calculatedBMI formula: bodyweight in kg divided by height in metres squared (kg/m2). BMI = 70kg/(1.75)2 = 70/3.0625 = 22.9


Psychological well-being There is evidence suggesting a link between obesity and psy-chological disorders such as depression. Although the causal pathway is diffi cult to determine (are the depressed more likely to become obese or the obese more likely to become depressed?), the development points to increasing future prob-lems on many levels.

Use and abuse of prescription drugs Growing numbers of workers use stimulants and anti-dementia drugs to optimise their performance. Antidepressants are also often used without diagnosis to achieve a heightened sense of mental well-being. In general, such “off-label” use of any medi-cation (for a purpose other than that for which it has been approved) is inherently risky. The known side effects of amphet-amine-based stimulants include headaches, loss of appetite, nervousness and sleeplessness. They can also become addic-tive. Yet acceptance of prescription drug use to boost perfor-mance in today’s competitive working world, even when mild side effects must be expected, is high in many countries. Amphetamine-based stimulants designed to treat attention-def-icit hyperactivity disorder (ADHD) are already in use as cogni-tive enhancers in signifi cant numbers (see Figure 7, Global upswing in stimulant usage). In Germany alone, around two million employees report having used medication to improve their work performance. And evidence suggests that this is just the beginning: a new generation of pharmaceuticals aimed at treating cognitive decline – with considerable potential as so-called neuroenhancers – is emerging.

Depression and obesity may be linked. Science Daily, 6 June 2008

Future challenges

4.1% of US undergraduates have taken prescription stimulants for non-medical purposes. University of Michigan Substance Abuse Research Center, 2005


Overdoing it Experts agree that many stimulants can lead workers to over-estimate capabilities, become euphoric and develop sleeping disorders. Although it is currently diffi cult to quantify their im-pact on occupational accidents, these factors clearly have the potential to cause dangerous situations – especially where machines or vehicles are involved.

Under pressure As can be expected, use of cognitive enhancers is most preva-lent in high-pressure occupations. In some cases, employees have felt compelled to begin using neurological medication just to keep up. This could result in an “arms race” that would fur-ther increase pressure to perform – an important factor in many physical illnesses and psychological disorders.

Unknowns As the development pipeline produces new neurological phar-maceuticals, increased off-label use must be expected. Precisely how this will affect health and safety in the workplace remains to be seen. Although no direct comparison can be made with alcohol or illicit drug use, it is interesting to note that alcohol has been shown to increase the likelihood of an occupational accident by a factor of two or even three (United Nations 1993).

The sum total The total effect of these issues must be expected to add up to far more than the sum of their individual parts. It is important to note that the four aspects discussed above represent only a lim-ited view of the overall future workers’ compensation world. A brief look at the fi ve other factors reveals – among other things – that compounded effects involving multiple scenarios can play a major role. Migration, for example, not only puts workers in situations where they are unfamiliar with the language as well as local working habits (notably safety and health procedures), it also tends to place them in positions outside of their actual occupations – a source of accidents and heightened on-the-job stress. Chronic diseases and musculoskeletal disorders increase signifi cantly with both age and excessive body mass. Psycho-logical disorders encourage use of prescription neurological drugs, and have been linked to weight gain. And all of these fac-tors are likely to strain regulatory frameworks and contribute to increasingly frequent and complex litigation.

20% of German employees consider medication to boost on-the-job perfor-mance justifi able, even without medical indication. Recent survey by the German health insurer DAK

The majority of “Nature” readers say healthy adults should be permitted to use neuroenhancers. Recent poll by the scientifi c journal Nature

Legal sales of prescription drugs containing methyl-phenidates (group of amphetamines), mainly used for ADHD treatment has increased tenfold since 1998. Toennesmann, 2008

Use of prescription antide-pressants with the active ingredient fl uoxetin has increased by 43% between 2005 and 2007. Recent survey by the German health insurer DAK


Jarmo Jacobsson (left) and Andrés Angel (right) speaking at the Workers‘

Compensation Symposium

In March 2009, the Munich Re Centre of Competence for Workers’ Compensation hosted an international symposium to look at the future challenges facing different systems all over the world. While at the three-day event, two decision-makers with major workers’ compensation organisations commented on the role of the Centre of Competence in tackling the challenges that lie ahead.

“We have a relationship of nearly ten years with the Centre of Competence. And I think it’s a unique unit, worldwide. There are a lot of organisations studying health and prevention strategies and how to reduce medical costs or whatever, but not many dealing with the insurance part.”

“So I think that’s the main benefi t of the centre. If you take into account that they are always trying to understand what’s happening all around the world, and actually when they go, for example, to a country like Colombia, people listen to them. The govern-ment listens to the centre, because it’s been studying developments all around the world. If, for example, they’re thinking of changing a new defi nition in the laws, well the Centre of Competence has a lot of information that helps those governments or those companies to do a better job.”

“And it helps to have a good partner, which is how we see Munich Re and the Centre of Competence; as a partner, a long-term partner for our reinsurance programme. Basically, you feel better when you know your partner knows at least as much if not more than you know. Because you have a good and strong relationship and good discussion of the prob-lems of the future and how we can tackle those chal-lenges. Or we can ask whether there are situations anywhere else in the world like the ones we face in Colombia.”

Andrés AngelVice-PresidentInversura SAInversura SA is the holding company of Susalud (HMO) and Suratep, Colombian workers’ compensa-tion insurer.

“I have worked for this organisation for eight years, but I have a long history in the Finnish insurance industry and I’ve been involved in the workers’ com-pensation system. We have a kind of market pool in Finland, and I know that Munich Re has been a leader in this pool since the 1960s – quite a long time. A long-standing relationship, as it used to be in reinsur-ance. As I think it should be, even though of course we have competition.”

“But I think it’s very important that this kind of market player brings together all different players and also the public sector, because it’s very inspiring to hear different views, and this is the kind of line that always involves the public sector – occupational health, occupational diseases – so it’s fantastic that this com-petent international player is actually organising this kind of forum. Of course I understand that there’s a long-term business idea behind it – and there has to be.”

“To be honest, this is a very, very diffi cult line of insurance and it’s good to understand how it is done in other countries. Of course we offer our experience too, because this is a long-term investment: if you give something, you’re going to get something. It’s a normal situation. So it’s fantastic to have this kind of forum – this is unique. We have casualty seminars, property or D&O seminars, but workers’ compensa-tion is very special.”

Jarmo JacobssonChief Actuary, DirectorFederation of Accident Insurance Institutions (FAII), FinlandThe FAII coordinates all organisations involved in Finland’s statutory accident insurance.


Conclusions Awareness, dialogue and cooperation are called for

This paper does not intend to provide actual forecasts or solu-tions to future challenges, but rather to inspire lively dialogue and information sharing. At the same time, it seeks to present thoughts and fi ndings that should become part of the discus-sion on the future of workers’ compensation.

The developments looked at here are real and for the most part unstoppable. Some are in their infancy, like the use of cognitive enhancers, while others, such as musculoskeletal disorders, have been with us for many decades, yet are taking on new dimensions. It cannot be stressed enough that no single chal-lenge can be isolated. They all have considerable potential to compound one another, leading in many cases to occupational diseases and accidents of greater frequency and/or severity as well as to unprecedented legal complexity. It will become more and more diffi cult to determine whether claims are linked directly or indirectly to work. Increasing migration will mean multiple workers’ compensation systems and policies in differ-ent countries will often be involved in a single case. How can it be proved or disproved, for example, that a worker of advanced age suffers from lower back pain as a result of work? And how can labour histories of workers moving between countries, sys-tems and regulatory frameworks – and often changing occupa-tions on the way – be suffi ciently documented?

To ensure that workers’ compensation insurance can continue to fulfi l its intended role – to protect workers and their families from fi nancial burden in the event of an occupational accident and/or a disease and to give employers clear cost frameworks – it is time to think about how much the world in which it must function is changing. Systems should operate as smoothly and fairly as possible, with a maximum degree of openness to work-ers and a minimum of litigation.

Stability built on perfect balance Above all, the four basic mechanisms of social insurance – defi -nitions, benefi ts, coverage, fi nancing – must be kept in perfect balance to ensure future stability. The needs of all directly involved parties including employees, employers and the state as well as indirect stakeholders – in a broader sense, all of society – must be met. This calls for a heightened spirit of co-operation and transparency among all involved in the world’s


workers’ compensation systems. In general, claims management will play a more prominent role, as will knowledge management and a more technical approach to understanding insured risks. Sharing methods and technologies that enhance effi ciency – examples include state-of-the-art data capture and manage-ment systems, discussed at the Fourth Workers’ Compensation Symposium hosted by the Munich Re Centre of Competence for Workers’ Compensation in March 2009 – is a good start. In addition, the challenges looming on the horizon will compel risk carriers and lawmakers to closely monitor the shifting risk landscape and what it means for the defi nition of events and conditions that trigger claims (triggers) and premiums.

The time is ripe for all workers’ compensation systems to sub-ject current reserves – notably IBNR (incurred but not reported) and IBNER (incurred but not enough reserved) – to a stress test in order to determine whether they are suffi cient to meet the challenges ahead. Especially in light of the fact that most emerging risks affect multiple groups including traditionally low-risk groups like offi ce workers, a very close look at the logic used to defi ne premiums (loadings) might be useful. The cat-egorical pricing approach, the allocation of industry types to specifi c or recommended tariffs or tariff ranges used in many countries, might not be valid in tomorrow’s world.

For 125 years, workers’ compensation insurance has been serv-ing as an anchor of fi nancial security and social stability. During that time, it has seen war and economic crises come and go. Entirely new industries and technologies have emerged, and previously unknown occupational diseases have appeared. Throughout all these developments, the concept of workers’ compensation insurance has endured. Provided stakeholders maintain an awareness of new developments and engage in open dialogue aimed at fi nding the best possible solutions for all parties, workers’ compensation systems can master the chal-lenges of the 21st century too.

Conclusions

“I expect future pressure on premiums. On the claims side, there will be pressure from private medical providers seeking profi t. Among claimants relapses or demands for permanent incapacity revi-sions will increase. And more regulatory control from supervisors and less reliability on fi nancial income from technical provisions will cause com-bined ratio fi gures to climb.”

“Although we have a fi xed price, my perception is that in the near future there will be adjustments in the pricing formula to accommodate the increase in

claims, but not in the recalculation algorithm. The inclusion of new diagnoses which are borderline with non-job-related diseases will impose a further burden on claims and costs.”

“With the current fi nancial crisis, major factors like weakening wage and salary growth and the overall reduction in investment are expected to slow growth in workers’ compensation insurance. At the same time, medical costs continue to rise. This trend threatens to cause higher combined ratios for both the public social security administrator and private insurers writing workers‘ compensation business.”

Francisco de Bras OliveirasCaixa Seguros é Saúde, Portugalspeaking at the workers’ Compensation Symposium 2009 in Munich.

Alejandro MoralesMutual de Seguridad, Chilespeaking at the workers’ Compensation Symposium 2009 in Munich.

Jawad JanebJordan Insurance Companyspeaking at the workers’ Compensation Symposium 2009 in Munich.


European Agency for Safety and Health at Work. European Union [http://europe.osha.eu.int].

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Kappos, A.D., P. Bruckmann, T. Eikmann, N. Englert, U. Heinrich, P. Hoppe, E. Koch, G.H.M. Krause, W.G. Kreyling, K. Rauchfuss, P. Rombout, V. Schulz-Klemp, W.R. Thiel and H.E.Wichmann, 2004: “Health effects of particles in ambient air”. Int. J. Hyg. Envir. Heal., 399–407.

Martens, W.J.M., “Health Impacts of Climate Change and Ozone Depletion: An Ecoepidemiologic Modeling Approach”– Environmental Health Perspectives * Vol. 106, Supplement 1, February 1998.

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Ramsey, J., 1995: “Task performance in heat: a review”. Ergonomics, 154–165.

Ramsey, J., C. Burford,M. Beshir and R. Hensen, 1983: “Effects of workplace thermal conditions on safe working behavior”. J. Safety Res., 105–114.

Randolph, S.E., 2001: “The shifting landscape of tick-borne zoonoses: tick-borne encephalitis and Lyme borreliosis in Europe”. Philos. T. Roy. Soc. Lond. B, 1045–1056.

Rao, S., J. Ku, S. Berman, D. Zhang and H.Mao, 2003: “Summertime characteristics of the atmospheric boundary layer and relationships to ozone levels over the eastern United States”. Pure Appl. Geophys., 21–55.

Rosenzweig, C., G. Casassa, D.J. Karoly, A. Imeson, C. Liu, A. Menzel, S. Rawlins, T.L. Root, B. Seguin, P. Tryjanowski, 2007: “Assessment of observed changes and responses in natural and managed systems”. Climate Change 2007: Impacts, Adaptation and Vulner-ability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change, M.L. Parry, O.F. Canziani, J.P. Palutikof, P.J. van der Linden and C.E. Hanson, Eds., Cambridge University Press, Cambridge, UK, 79–131.

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Toennesmann, J. In Wirtschaftswoche, 20.10.2008, Nr. 43, p.138–143.

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References:

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Order number 302-06153

FUTURE CHALLENGES IN WORKERS‘

COMPENSATION INSURANCE AN OPPORTUNITY FOR INTERNATIONAL COOPERATION

21 June 2011

Dr. Hector Upegui, MD

CoC for Workers’ Compensation Insurance Dr. Héctor Upegui, MD. ,

Our Unit -

History and Main Activities

MR WORKERS’

COMPENSATION UNIT WAS ESTABLISHED IN 1998 ASCENTRE OF COMPETENCE

Observe and accompany private participation and/or reform processes

Develop worldwide opinion leadership position for comparing and developing

systems either with private participation &/or public Workers’

Comp. Systems

Provide advice and service on both insurance and reinsurance questions, from

legislative to operational

Exchange know how and expertise with Munich Re America

Generate substantial reinsurance business for Munich Re

Concentrate and amplify expertise within the Munich Re Group

2


Introduction –

General Characteristics

Workers‘

compensation insurance provides coverage in order to help the insured and the families to overcome the burden of an occupational injury or an

occupational disease

Some major characteristics of WC systems:

No fault

Compulsory

Highly regulated

Employer pays

Links to Social Security systems

3


New trends of occupational hazards

Developments in last decades in hazards whose effects appear Long after exposure long-latency risksAs well as diseases with multiple causes multi-causality risks

Which trends do we see for the future?

Future challenges in Workers’

Compensation Introduction

4


Definition: Any condition that might affect the performance of a

Workers'

Compensation System

The condition/challenge must follow the following criteria :

Independent: should be able to affect any workers' compensation system, independently of the way in which it operates (under competition, without competition, public, with private participation, etc.)

International: should be able to affect any workers' compensation system, independently of the country or territory where the system operates

Important: where the expected impact in terms of frequency and severity is important enough to raise awareness

Identifiable: there should be evidence to show that the risk/condition might cause an impact on the workers' compensation insurance


Compensation

5

CoC for Workers’ Compensation Insurance Dr. Héctor Upegui, MD. , 6

Under the 4I’s criteria Under the 4I’s criteria

*Multicultural-lingual environments

Obesity Obesity

Migration (MC, ML)* Migration (MC, ML)*

Psycholo- gical

Psycholo- gical

Climate change Climate change

Old ageing

workforce

Old ageing

workforce

Musculo- skeletal

Musculo- skeletal

Prescrip tion drugs

abuse

Prescrip tion drugs

abuse

Clash of Laws

Clash of Laws

Chronic diseases Chronic diseases


Compensation


Defined as a body mass index (BMI) above 30

Considered to be a global epidemic by the International Obesity

Task Force and the World Health Organisation

Obesity is also an issue of tomorrow: According to the British Medical Association 30.3% of boys and 30.7% of girls were overweight in 2002 (thereof 16% obese)


Compensation Obesity

7

Source: WHO, Global Database on Body Mass Index, Oct. 2010

Country Females Males

% of population aged 15+

Ranking amongst 192

countries

% of population aged 15+

Ranking amongst 192

countries

Belgium 11 140 14 62Chile 39 23 24 23Colombia 26 58 20 36Denmark 8 147 12 80Finland 19 93 21 31Germany 22 79 23 26Norway 11 141 13 73Peru 38 28 18 44Portugal 18 103 16 59USA 48 13 44 5

Formula: Body weight in kg divided by body height in m, which is

squared. e.g. 100kg, 2 m tall person: 100/(2*2)= 25

Vorführender

Präsentationsnotizen

The definition for being obese is a body mass index (BMI) above 30. Formula: Bodyweight in kg divided by bodyheight in meters, which is squared. e.g. 100kg, 1,75 cm tall person: 100/1,75*1,75= 32 If we have a look on the graphic of the WHO: In the selected European Markets we have minimum 10% (at least when we talk about the male population) of the population which is defined as obese. The highscorer in this table for Europe is Germany, where we even define 20% of the population as obese. The UK is already 24% Compared to that – we see a dramatic trend in New Zealand. Some experts and institutions like the Obesity Task Force and the WHO consider obesity to be a global epidemic. (last bullet point) Already in 2002 the British Medical Association indicated that 30% of the boys and girls were overweight (BMI > 25), including 16% who were obese. This means, 6 years ago in the UK burden for common health system But as the children of the past will be the future employees OA and OD will be triggered by the development as well.




8

Formula: Body weight in kg divided by body height in m, which is squared.

e.

g. 100kg, 2 m tall person: 100/(2*2)= 25


Obesity Research

NCCI Research Brief –

Nov 2010:

“

RESERVING IN THE AGE OF OBESITY”

Some Key Findings:

Obese claims are more expensive than non-obese claims, and the differences in costs are magnified as the claims mature

Obese claims are 2.8 times more expensive at the 12-month maturity



The cost difference (at the five year maturity) is less for females than for males.

Mandatory utilization review and, in particular, mandatory bill review significantly reduce the cost difference between obese and non-obese claims.


Obesity(Overlapping with other future challenges)

BenefitsPrevention Cash/Kind

Rehabilitation

•Accident risk can arise

•

Workplaces and personal protective equipment not adjusted to this specific working population

•

Increased costs for temporary incapacity

•

Higher possibilities of having more invalidity pensions

•Medical costs are higher, due to asso-

ciated common disea-

ses, as well as the need of longer stay at the hospital

•

More technical barriers for Return to work programs

• Costly interventions

•

Adjustment of working and living environment can be more expensive



1.

Obese workers were significantly more likey to report „lost productive time“

(J. Cheadle et al., 1994, „Factors influencing the duration of work-related disability“)

2.

Excessive BMI (> 40) does not prevent gains during inpatient rehabilitation, however, these gains are made less efficiently and at a higher cost. (H.K.&K.R. Vincent, 2008, „Obesity and inpatient rehabilitation outcomes following knee arthroplasty“)

3.

Employees (BMI > 40) compared to employees (BMI < 25)

•

Had 12 claims compared to 6•

Lost workdays 184 vs 14•

Medical claims costs of US$ 51,091 vs. US$ 7,503

•

Indemnity claims costs of US$ 59,178 vs. US$ 5,396

(T. Ostbye et al., 2007, „Obesity and workers‘

compensation: results from the Duke Health & Safety Surveillance System

“)

10




Obesity Obesity


Psycholo- gical

Psycholo- gical


Old ageing

workforce

Old ageing

workforce

Musculo- skeletal

Musculo- skeletal

Prescrip tion drugs

abuse

Prescrip tion drugs

abuse

Clash of Laws

Clash of Laws



Compensation


Old ageing workforce(Overlapping with other future challenges)


Rehabilitation

•

Aural and visual perceptive faculty are diminishing

•Reaction time is getting up

•

Accident risk can arise

•

Compensation possible by know-how and operating experience

•


•


•

Adjustment of reserves to pay out pensions in the future

•

Medical costs are higher, due to asso-



•

More technical barriers for Return to work programs


•

Adjustment of working and living environment can be more expensive


Compensation Old ageing workforce

1.

Severity of injury, older age, female gender predict longer duration of disability (A. Cheadle et al., 1994, „Factors influencing the duration of work-related disability“)

2.

Positive linear relationship between age and costs was observed (G.A. Wood et al., 1995, „Factors influencing the cost of workers‘

compensation claims...“)

3.

Most significant individual predictors of „RTW“

status were edu-

cation, age,...(Blackwell et al., 2003, „Predictors of vocational rehabilitation RTW outcomes in WC“)

12




Obesity Obesity


Psycholo- gical

Psycholo- gical


Old ageing

workforce

Old ageing

workforce

Musculo- skeletal

Musculo- skeletal

Prescrip tion drugs

abuse

Prescrip tion drugs

abuse

Clash of Laws

Clash of Laws



Compensation

CoC for Workers’ Compensation Insurance Dr. Héctor Upegui, MD. ,Source: Christine Kieffer. European forum, Copenhaguen 2008


Compensation Psychological disorders

14


WHO “Integrating mental health into primary care”, 2008


Compensation Psychological disorders

High workers‘ compensation costs were related to individual health risks, especially Health Age Index, smoking, poor physical health, physical inactivity ( Obesity, old age) and life dissatisfaction ( depression, psychological disorders. )(S. Musich et al., 2001, „The association of health risks with workers‘ compensation costs“) 15


Psychological Disorders(Overlapping with other future challenges)


Rehabilitation

•Reaction time is getting up

•

Accident risk can arise due to lack of concentration

•Use and abuse of prescription drugs (e.g. stimulants, anti-

depressants, anti-

dementia)

•


•


•

Medical costs are higher, due to asso-





Compensation Psychological Disorders

1.

Level of depressive symptoms is a strong predictor of returning to work. (P. Ash, 1995, „Predictors of returning to work“)

2.

Depressive component, if left untreated, would hinder significantly rehabilitation.(Monsein, Cliff, 1995)

3. Cognitive behavioural therapy has a useful role in the rehabilitation of people on WC compensation who are seeking employment.

(C.Della-Posta, 2006, „CBT increases re-employment of job seeking WC clients.“)

16




Obesity Obesity


Psycholo- gical

Psycholo- gical


Old ageing

workforce

Old ageing

workforce

Musculo- skeletal

Musculo- skeletal

Prescrip tion drugs

abuse

Prescrip tion drugs

abuse

Clash of Laws

Clash of Laws



Compensation

CoC for Workers’ Compensation Insurance Dr. Héctor Upegui, MD. ,Source: Christine Kieffer. European forum, Copenhaguen 2008


Compensation Musculoskeletal disorders (MSD)

18


FUTURE CHALLLENGES

Old ageing workforce ObesityMusculoskeletal Migration PsychologicalClimate change Chronic diseasesPrescription Drugs abuse Clash of laws


Compensation Conclusions

19


FUTURE CHALLLENGES


EXPECTED

↑Litigation↑life expectancy↑ medical costs↑ cost of care↑ disability

Cost d

river

s

for W

CI Clai

ms



20


FUTURE CHALLLENGES


EXPECTED


CONSEQUENCES

↑ reserves. Especially, IBNER & IBNR

↑ investment in claims management (health care and care)

↑ return to Work programs↑ investment in knowledge

management

Cost d

river

s

for W

CI Clai

ms

Press

ure o

n

the pr

emium



21


FUTURE CHALLLENGES

Old ageing workforce ObesityMusculoskeletal Migration PsychologicalClimate change Chronic diseasesDrugs/Medicaments abuse Clash of laws

EXPECTED


CONSEQUENCES

↑ reserves. Especially, IBNER & IBNR

↑ investment in claims management (health care and care)

↑ return to Work programs↑ investment in knowledge

management

Cost d

river

s

for W

CI Clai

ms

Press

ure o

n

the pr

emium

ACTIONS AND SOLUTIONS

Macrolevel: More lobby, improve contact with social policy makers and decision takers

Generate platforms, forums, to foster the exchange of knowledge (Risk knowledge) transform the risk (Claims management, RTW, etc.)

Create new scenariosRethink triggers



22


THANK YOU VERY MUCH!

Dr. Héctor

Upegui, MDSenior Consultant

[email protected]

mailto:[email protected]

Employment of People with Disabilities in Ireland: Research and Strategy

Mary Van Lieshout

What the National Disability Authority does

• Provides policy advice to the Irish Government and public bodies

• Undertakes, commissions and collaborates in disability research and assists

in the development of statistical information

• Advises on standards and guidelines in services to people with disabilities

• Develops standards, education and awareness of Universal Design

Data on employment of people with disabilities• In the 2006 Census, the employment rate of people with disabilities was less

than half that of those without, at 21.6% to 57.2%

• In the same census, people with disabilities made up 4% of the total number

of those in employment

• According to a 2006 survey for the National Physical and Sensory Disability

Database, 57.1% of respondents experienced participation restriction in the

area of employment and job seeking

• Approximately 70% of people with disabilities acquired them since birth

(QNHS 2002)

Researching the employment of people with disabilities in Ireland• Disability and Labour Market Participation, a 2004 report produced by the

ESRI for the Equality Authority, notes that such surveys as currently exist are

better at measuring levels of labour and employment than they are at

measuring gradations of disability

• Different datasets such as the Census, the QNHS and the Living in Ireland

Survey vary in their definitions of both employment and disability

• The NDA, on behalf of the CSO, has represented Ireland in the work of the

Washington City Group on setting global standards of disability statistics

Employment policies for people with disabilities• The relevant chapter in Disability and Social Policy in Ireland (2003),

identifies three modes of policy in operation:

– Obligatory non-discrimination and actions to reasonably accommodate: legislation

including the 1998 Employment Equality Act and the 2005 Disability Act

– Voluntary positive action: including sheltered, supported and rehabilitative

employment

– Voluntary targets: the 3% quota for employment in the civil and public service

The 3% Target

• Under the 2005 Disability Act the NDA has a statutory role in monitoring the

compliance of public bodies with Part 5 of the Act

2008 Report

http://www.nda.ie/website/nda/cntmgmtnew.nsf/0/584C604587AEE6BE8025768D00574AFE?OpenDocument

Welfare entitlements relating to disability and employment• The main social welfare payments for people with long-term illness or

disabilities are the invalidity pension, the means-tested disability allowance,

and the blind pension

• Upon written approval, people receiving disability payments can engage in

rehabilitative or therapeutic work while keeping their payments

• In addition, there are a range of secondary benefits due to those who are

receiving social welfare disability payments, which may be retained according

to earnings

Difficulties

• A Strategy for Engagement: Towards a Comprehensive Employment

Strategy for People with Disabilities (NDA, 2006) identifies persistent

inequality both in the area of educational qualifications and dependency on

welfare payments

• It also describes the pre-existing experience of people with disabilities in

Ireland as one of ‘unequal treatment’ and the current system of welfare and

employment measures as ‘an outdated model’

Challenges

• Further challenges observed in the Strategy for Engagement include:

– The ‘moving on’ of the employment market towards more high-skilled jobs

– Relatively few companies have experience in accommodating workers with less

restrictions, and even fewer those with more severe restrictions (the demand side

of employment of people with disabilities)

– The heterogeneity of the population of people with disabilities in terms of their

circumstances, needs and abilities, which must be taken into account in policy

– Whether it is a voluntary choice to work fewer hours, in part-time or self-

employment, or if it is an effect of the welfare system or the workplace

Pillars of a Strategy of Engagement

• Six pillars are identified on which to base a comprehensive strategy:

1. Removing benefit traps and disincentives towards working in the welfare system

2. Enhancing the effectiveness of education and training to ensure that people with

disabilities can compete in the current and future labour markets

3. Ensuring demand-side awareness of disabilities in the labour market

4. Devising preventative strategies to reduce early school-leaving, and to improve

retention in employment following adult-onset disability

5. Engaging with people with disabilities and their employment aspirations

6. Ensuring that the provision of the above is sufficiently diverse to meet the needs

of all people with disabilities, especially those experiencing severe disabilities

Benefiting from the Irish experience

• From a recent speech by the Minister for Health, Dr. James Reilly

– “Under the new Universal Health Insurance system everyone will have health

insurance from their choice of insurance company. This insurance will guarantee

every citizen equal access to a comprehensive range of hospital and medical

services. Moreover, it will offer greater transparency for people by directly linking

their payments on health insurance to an associated level of benefits or service

entitlements.

The core purpose of universal health insurance is to achieve equity of access to

healthcare. Similarly, the concept of equity will inform the internal design of the

insurance system which will be based on community rating and a robust risk

equalisation scheme, governed by a new Regulator – the Hospital Insurance

Fund.”

Accident insurance systems

• Ireland is keen to learn from international best practice in

this area

• In order to advise our government, the NDA is keen to

have access to further details on systems, costs, and

outcomes for people for disabilities of such schemes

suva

Die Suva ist mehr als eine Versicherung Kurzporträt Die Schweizerische Unfallversicherungsanstalt (Suva1) ist die wichtigste Trägerin der obligatorischen Unfallversicherung in der Schweiz. Gut die Hälfte der Schweizer Berufstätigen (rund 2 Millionen Versicherte in 115 000 Unternehmen) sind bei ihr gegen die Folgen von Unfällen in Beruf und Freizeit sowie gegen Be-rufskrankheiten versichert. Die Suva ist ein selbständiges, nicht gewinnorientier-tes Unternehmen des öffentlichen Rechts (Non-Profit-Organisation). Sie arbeitet selbstragend, ohne öffentliche Gelder und gibt Gewinne in Form von tieferen Prämien an die Versicherten zurück. Im Verwaltungsrat sind die Sozialpartner - Arbeitgeber und Arbeitnehmer - und der Bund vertreten. Die Suva bietet ihren Versicherten einen ganzheitlichen Gesundheitsschutz. Ihre Dienstleistungen umfassen Prävention, Versicherung und Rehabilitation. Im Auf-trag des Bundes führt sie seit 2005 auch die Militärversicherung. Rund 3000 Mit-arbeiterinnen und Mitarbeiter stehen für die Versicherten im Einsatz, davon 600 in ihren beiden Rehabilitationskliniken. Luzern, Mai 2011

1 www.suva.ch

Felix Weber

Suva, Member of Business Management

Rehabilitation and Return to Work/Dresden 22 June 2011

Suva claims management: a quality programme designed to contain rehabilitation costs

Bild ?

Vorführender

Präsentationsnotizen

Conference forum 21/22 June 2011 in Dresden Panel :“Rehabilitation and Return to Work“ - 22 June (a.m.) Speaking time approx. 20 minutes Talk in German/ Slides in English

AGENDA

1 Suva at a glance

2 Occupational reintegration – a key concern for Suva

3 Suva’s claims management

Goals

Three processes

Focus on complex cases

4 Experiences and results

2

Suva at a glance

Companies insured 115,300

People insured 1,959,000

Accidents and occupational diseases 448,800

Number of employees 3,000

Total salary insured CHF128bn

Gross income from premiums CHF 4.2bn

Insurance benefits (treatment costs, daily benefits, pensions and cost-of-living allowances)

CHF 3.9bn

Operating costs of which for prevention (occupational and leisure-time safety)

CHF 520m CHF 117m

Suva (the Swiss National Accident Insurance Fund) – an institution under public law – is the most important provider of compulsory accident insurance in Switzerland.

3

Suva insurance benefits

-> Resources are concentrated on cost-intensive cases

Cost categories Cost intensity

Pensions

Daily benefits

Treatment costs5%

30%

65%

4

70% of cases 28% of cases 2% of cases

Occupational rehabilitation - a key concern for Suva

5

Suva – more than just insurance:A combination of prevention, insurance and rehabilitation.

Occupational reintegration - benefits for everyone

6

Personal benefits for accident victims•They regain their independence•They participate in everyday working life•They are not socially excluded

Financial benefits for insurers and insurees• Reduction in cost-intensive pension benefits lower premiums

Social benefits• Advantages for society in general

Occupational reintegration - what Suva offers:

7

• Comprehensive care and support for seriously injured insurees

• Work-oriented rehabilitation at Suva clinics

• Occupational reintegration initiative: an incentive system for employers

• Cooperation with other insurers (mainly concerning disability insurance) and institutions

• Cooperation with employment agencies

The emphasis is placed on a return to the previous workplace. Occupational reorientation as far as this is necessary.

AGENDA

1 Suva in brief

2 Occupational reintegration – a key concern for Suva

3 Suva’s claims management

Goals

The part-processes

Focus on complex cases

4 Experiences and results

8

Goals of claims management

9

High-quality, customer-friendly, effective and economical claims management

The part-processes

Normal

Complex

Standard

10

Severely injured victims (e.g. people with cerebral injuries, serious multiple injuries)

Cervical spine injury victims unable to work > 4 weeks

Psychological complaints

Cases of anticipated disability

Workplace at risk or even the loss of a workplace

Foreseeable or existing reintegration problems

Difficult social environments

.......

Management of complex cases (1)

A vital role is played not only by the injuries themselves, but also by the “soft factors” as they are known. These are the accident victims’ personal and, in particular, occupational backgrounds.

11

Komplex


“Case Management” does not mean that the accident victims are managed. Instead, it is the extraordinary situation in which the victims find themselves that is managed.

Timely, comprehensive and intensive care as well as the specific promotion of victims’ occupational reintegration with full regard for their personal resources (“encourage + expect”).

Coordination of medical and occupational rehabilitation measures.

Goal-oriented assistance and care from “A – Z” by one case manager right from the time of the accident itself if possible.

12

Case Managers:• Insurance specialists with high-level specialist, social,

communication and leadership skills• Practice-oriented training in in-house suva workshops• Regular specialist and behavioural further training


1 Opening

2 Analysis

3 Planning

4 Case Management

5 Closing

13

Experiences and results (1)

14

Satisfied customers and partners

Measurement of customer satisfaction in 2010

Reliability

Information and communication

Prevention of non-occupational accidents

Premiums

Rehabilitation and occupational reintegration

Claims management

Prevention of occupational accidents/diseases

Appreciation

Expertise

Measures to contain accident costs

Initiative


15

Insurance benefit savingsDevelopment of the number of newly assessed disability pensions


16

Insurance benefit savingsDevelopment of pension costs in millions of CHF

www.suva.ch

18

Factsheets• Das Schadenmanagement der Suva• New Case Management• Berufliche Reintegrationhttp://www.suva.ch/startseite-suva/service-suva/informationsmittel-suva/factsheets-unfall-suva.htm

• La gestion des cas de la Suva• New Case Management• Réintegration professionellehttp://www.suva.ch/fr/startseite-suva/service-suva/informationsmittel-suva/factsheets-unfall-suva.htm

• La gestione dei casi alla Suva• New case management• Reinserimento professionalehttp://www.suva.ch/it/startseite-suva/service-suva/informationsmittel-suva/factsheets-unfall-suva.htm

lic. oec. HSG Felix WeberMitglied der GeschäftsleitungSuvaCH 6002 Luzern, [email protected] www.suva.ch

http://www.suva.ch/startseite-suva/service-suva/informationsmittel-suva/factsheets-unfall-suva.htm

http://www.suva.ch/fr/startseite-suva/service-suva/informationsmittel-suva/factsheets-unfall-suva.htm

http://www.suva.ch/it/startseite-suva/service-suva/informationsmittel-suva/factsheets-unfall-suva.htm

Europäisches Forum der Versicherungen gegen Arbeitsunfälle und Berufskrankheiten Konferenz Dresden 21. - 22. Juni 2011

Rehabilitation and Return to Work

Beispiel eines kostendämpfenden Qualitätsprogramms in der Rehabilitation: Das Schadenmanagement der Suva

Abstract

Die Suva Die Suva (Schweizerische Unfallversicherungsanstalt) - eine selbständige öffentlich rechtliche Institution - ist die wichtigste Trägerin der obligatorischen Unfallversicherung in der Schweiz. Gut die Hälfte aller Arbeitnehmer der Schweiz (rund 2 Mio. Versicherte) sind bei ihr gegen die Folgen von Unfällen und Berufskrankheiten versichert. Die Suva wird von den Sozialpartnern geführt. Sie ist selbsttragend; sie erhält keine öffentlichen Gelder. Die Suva ist mehr als eine Versicherung: sie vereint Prävention, Versicherung und Rehabilitation (www.suva.ch). Jährlich melden die Betriebe rund 450 000 Unfälle und Berufskrankheiten der Suva. Dabei führen 70 % der Schadenfälle lediglich zu 5 % der Versicherungskosten. 2 % der gemeldeten Fälle hingegen verursachen fast zwei Drittel der gesamten Versicherungsleistungen. Es han-delt sich dabei um komplexe Unfälle mit einem schwierigen Heilungsverlauf. Schadenmanagement Ziel der Suva ist, Verunfallten und deren Arbeitgebern ein qualitativ hochstehendes, kunden-freundliches und wirtschaftliches Schadenmanagement zu bieten. Damit alle Beteiligten den grösstmöglichen Nutzen haben, bearbeitet die Suva die Schadenfälle in drei verschiedenen Fallkategorien: Standard-, Normal- und Komplexfälle. Als Standardfälle gelten Bagatellunfälle ohne Taggeldanspruch sowie Fälle mit kurzfristigem Taggeldanspruch. Bei dieser weit überwiegenden Anzahl der Fälle steht für die Kunden die Entschädigungsfrage im Vordergrund und eine Beratung ist kaum gewünscht. Diese Fälle werden aus wirtschaftlichen Überlegungen mit minimalstem administrativem Aufwand und möglichst automatisiert verarbeitet. Ein wirkungsvolles Schadenmanagement kann hier ohne-hin kaum angesetzt werden, da die Schadenmeldungen vielfach erst nach Wiederaufnahme der Arbeit bei der Suva eintreffen. Normalfälle sind Schadenfälle, bei denen versicherungsrechtliche Probleme zu klären sind, sowie Fälle mit einer Arbeitsunfähigkeit von mehr als acht Wochen, die zu keinen Schwierig-keiten bei der Wiedereingliederung führen und voraussichtlich ohne Dauerschaden abheilen. Durch die persönliche Betreuung der Verunfallten wird die Rückkehr an den angestammten Arbeitsplatz gefördert und Komplexfälle werden vermieden. Dies erfordert unter anderem ei-nen guten Kontakt zu den Arbeitgebern der Verunfallten. Primäre Ansprechpersonen bei Ver-sicherungsfragen sind die Suva-Sachbearbeitenden. Im Zentrum des Schadenmanagements stehen die Komplexfälle, d.h. Unfälle und Berufs-krankheiten mit erschwerter Wiedereingliederung. Ziel ist es, diese kostenintensiven Scha-denfälle so früh wie möglich zu erkennen, um schnell mit einer umfassenden und individuellen Beratung und Betreuung der Verunfallten hinsichtlich medizinischer, sozialer und beruflicher Reintegration beginnen zu können. Die Verunfallten werden in enger Zusammenarbeit mit den Case Managern, Komplexschadenspezialisten, Kreisärzten und den eigenen Rehabilitati-onskliniken der Suva betreut. Je nach Bedarf werden weitere Suva-Experten und externe Spezialisten (z. B. Stellenvermittler) beigezogen. Ausgesprochen wichtig ist auch die Koordi-nation mit anderen Versicherungen wie z. B. mit der Invalidenversicherung.

Schadenmanagement bringt Mehrwert Kostenzahlen und Kundenbefragungen zeigen, dass die Suva mit der Gliederung ihres Scha-denmanagements auf dem richtigen Weg ist. Es bringt sowohl den Verunfallten, deren Arbeit-gebern und der Suva Vorteile. Die Anzahl und die Kosten der Neurenten konnten in den letz-ten Jahren massiv gesenkt und die Zufriedenheit der Verunfallten und deren Arbeitgeber ge-steigert werden. Lic. oec. HSG Felix Weber Mitglied der Geschäftsleitung Leiter des Departementes Versicherungsleistungen und Rehabilitation

INFORMATION ABOUT ARP SURA ARP SURA: A Colombian Workers’ Compensation Insurance Company History Law 100 of 1993 and specifically the Law decree 1295 de 1994, were the

basis for the restructuring of the Workers’ Compensation System. Suramericana de Seguros decided then to become part of the Social

Security System in Colombia. Starting studies and later creating ARP SURA as a Workers’ Compensation Administrator.

Since 1996 until now, ARP SURA has been the leader among privates ARP’s. In order to guarantee its quality service ARP Sura has developed a quality system certified by ICONTEC under ISO 9001:2000.

The Business ARP SURA is a Worker Compensation Insurance Company (ARP),

subsidiary of SURAMERICANA. ARP SURA main function is to prevent, assist and protect all workers from

the effects caused by accidents or illnesses that may occur during the development of their work.

ARP SURA has 552 employees and 1.611.224 Affiliated Workers One main office located in Medellín.

Branches: Antioquia and Eje Cafetero: Offices in Medellín, Manizales and Pereira. Centro: Offices in Bogotá and Bucaramanga. Occidente Office in Cali. Norte: Offices in Barranquilla and Cartagena. Coverage in more than 1.000 cities and towns of Colombia

ARP SURA

MSD interventions in the Colombian Floriculture Sector - Practical application of

CUELA

Dr. Yanet Zapata Tamayo M.D.

Technical Manager

Prevention & Health Services

Dresden, June 2011

ARP SURA

AGENDA

• Current situation of Occupational Diseases in Colombia

• Integral approach: – How the problems were dealt with and what was the

contribution of CUELA in the overall approach

• Learning perspectives:– How to continue improving the knowledge acquired

and increase its impact

ARP SURA

CURRENT SITUATION

ARP SURA

ARP SURA

Occupational Diseases Rates in Colombian Workers’ Compensation System

0

2

4

6

8

10

12

14

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011(Feb)

5% 5% 3%9%

46%32%

In 2010 The rate in Agriculture sector is 38.13 per 10.000 insureds

1. Carpal Tunnel2. Hearing Loss3. Epicondylitis4. Tenosynovitis

Source: Fasecolda (Federation of Colombian Insurers)

ARP SURA

INTEGRAL APPROACH

ARP SURA

ARP SURA

General conceptual design

Proven Proven

interventions interventions

with wide and with wide and

recognised recognised

effectivness.effectivness.

Risk factors Risk factors

that affect that affect

workers of the workers of the

Colombian Colombian

floriculture floriculture

sectorsector

Define and implement Define and implement

interventions that have interventions that have

more probability of being more probability of being

effective.effective.

University

http://www.dguv.de/inhalt/index.jsp

ARP SURA

Search of existing interventions

Proven Proven interventions interventions with wide and with wide and recognised recognised effectiveness.effectiveness.

9072 articles

55 articles:0 Studies in

floriculture sector

Results:

Nothing has been published in scientific literature

about the effectiveness of ergonomic interventions

in the floriculture industry

University

ARP SURA

Occupational epidemiological study

Risk factors Risk factors that affect that affect workers of the workers of the Colombian Colombian floriculture floriculture sector sector

Self‐report questionary and Borg scale.

Analysis of repetitiveness

of a task

Electro‐

goniometry

Electro‐myography

16

BIOMETRICS: European

recommendations SENIAM

40

CUELA

80

Job Strain Index

160

Medical Exams

June

2008 September 2008 November

2008 March

2009

ARP SURA

Data visualisation and assessment – CUELA software

3D-Puppet

Synchronised

video file

Measurement data, e.g. angle time graph

ARP SURA

Results

Gender and age can be important determinants in MSDThe real time-records of CUELA generate great analytical precisionThe supination of the forearm, the flexion of the wrist, ulnar desviation, and the extreme elbow flexion, could be the main mechanical variables at work

University


ARP SURA

Definition and analysis of the impact of the interventions

Interventions Interventions with more with more probability of probability of being being effective.effective.

Decision of Decision of

improvements improvements

to be madeto be made

Measurement Measurement of impactof impact

Taller de expertos

Revisión conempleadores

Implementación contrabajadores

EXPERTS

EMPLOYERS

WORKERS

University

Self‐report questionary

Electro‐goniometry

Electro‐myography

Self‐report questionary

Electro‐goniometry

Electro‐myography


ARP SURA

Results

The real-time records of CUELA generated great confidence therefore the companies will participate in the most complex areas of the sector

Postures change in critical activities (post harvest and “poncheo”) as well as improved maintenance of scissors demonstrated a reduction of the risk in the short term (3 months after the intervention)

Have the technology and specialized advice generated the confidence within the floricultor sector, and allowed the impruvements and the possibility to make changes

University


ARP SURA

LEARNING PERSPECTIVES

ARP SURA

ARP SURA

This study was the first experience in the floricultor sector, and is the base for others investigations and publicationsThis knowledge will be available to the sector throught of simples toolsThe experience will be replicated in other economic sectors with significant prevalence of these types of occupational diseases

The design of the investigation could be apply with other

countries in the region such as Chile and Argentina

How to continue improving the knowledge

acquired and increase its impact.

ARP SURA

Thank you very [email protected]

Documents

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