Successful Legacy Claim Settlement Initiatives Featured in WorkCompWire Article

February 15, 2017

As part of its Leaders Speak series, WorkCompWire recently published a two-part article by Tower MSA Partners’ Chief Compliance Officer, Dan Anders, describing how clinically driven settlement initiatives on legacy or “old dog” workers’ compensation claims yield significant cost savings and become the foundation for best practices on new workers’ compensation claims.

Part one of the article, How Old Dogs Can Learn New Tricks, details how successful settlement initiatives include a clinical partner who identifies and analyzes legacy claim cost drivers and then works with the employer or carrier to separate claims into those that can immediately move to settlement negotiation, those that may settle after clinical or legal intervention, and those that are unlikely to benefit from intervention and thus cannot settle. The article explains the importance of connecting the appropriate clinical intervention to the legacy claim so as to drive a successful outcome and claim closure.

Part two of the article, New Tricks for New Claims, focuses on how the lessons learned in resolving legacy claims can be applied to new or ongoing claims and as a result produce significant medical and indemnity cost savings. Highlighted in the article is a large employer whose legacy claim settlement initiative yielded significant reduction in legacy claim costs and continues to save the employer ongoing claim costs as now a new standard for claims handling.

We encourage you to review the articles and contact Tower MSA Partners to discuss how we can drive case closure on your legacy or old and complex workers’ compensation claims.

Dan Anders may be contacted at or (847) 946-2880.

Workcompcentral Highlights Tower MSA CEO Rita Wilson’s “Edge” in MSP Compliance Technology

December 20, 2016

Tower MSA Partners CEO, Rita Wilson, is the subject of a recent Workcompcentral article, Focus on Tech Has Guided MSP Compliance Co. CEOs Career, highlighting how Rita’s career in building better pharmaceutical and worker’s compensation technology systems led her to develop a Medicare Secondary Payer (MSP) technology platform which electronically integrates medical and cost-containment information.

In discussing why the MSP compliance technology platform is a difference maker for Tower MSA, Workcompcentral’s Emily Brill quotes Rita:

Tower MSA has differentiated itself by building out a software system that monitors and shares claim information from beginning to end, integrating medical and cost containment information for “continuity” and to avoid “reinventing the wheel” by scrambling to get information from separate sources.

The article further quotes Rita in explaining how the platform assists Tower MSA in providing MSP compliance services to its clients:

Our technology platform is able to track claim information all the way through, through the conditional payment research process, through the intervention process, through the MSA process. What we did was integrate this information and track it with one software application that allows us to measure the progress each month, and determine when the right time to finalize the MSA.

In understanding the benefits of Rita’s focus on technology in MSP compliance, Ms. Brill spoke to Ann Schnure, the former Vice-President of Risk Management for Macy’s, and also a strong proponent of the use of technology in claims handling, who said of Rita:

Wilson’s focus on technology has always given the CEO an edge.

Learn more about Tower MSA Partners Chief Executive Officer Rita Wilson,  connect with her on LinkedIn and view her blog posts on our MSP Compliance Blog.

To learn more about how Tower MSA Partners’ technology platform can give you an “edge” in Medicare Secondary Payer Compliance please contact Rita Wilson at or 888.331.4941.

Tower MSA Partnership with American Airlines and PRIUM Yields Legacy Claim Settlements

December 8, 2016

In a widely acclaimed presentation at the recent 2016 National Workers Compensation and Disability Conference, Jennifer Saddy, Workers’ Compensation Director for American Airlines and Mark Pew, Senior Vice President of PRIUM, detailed the successful cooperation among American, PRIUM and Tower MSA to reduce pharmacy costs, litigation referrals and Medicare Set Aside costs ultimately leading to significant claim settlements.  Tower MSA is grateful to Jennifer and Mark for highlighting how Tower MSA’s Identification, Intervention and Involvement services were a key contribution to the success of this legacy claim reduction program.
For more information on American’s program please read the Risk & Insurance article Make a Decision and Move the Needle: American Airlines needed to take aggressive action to resolve 6,000 lingering workers’ compensation claims.

For more information on Tower MSA’s legacy claim reduction services please contact us at 888.331.4941 or

The VA’s Proactive Move on Opioids

October 3, 2014

I don’t need to reiterate how big a problem prescription drugs continue to be not only in the work comp industry as well as society, but I just did anyway. Recently I wrote here about the rescheduling of hydrocodone combination products and how it was a long overdue move for the DEA to make. As a reminder, the reclassification goes into effect on October 6, and this was no doubt the reason that the Veterans Health Administration sent a letter to my dad yesterday.

As well deserved as the scrutiny against the V.A. has been in recent months, the letter that they sent my father was an absolutely needed step and one that hopefully represents the direction in which the disgraced organization is heading.

It was a simple letter and you can see it by clicking on the link below, but the VA decided to take decisive action and inform what appears to be all patients who have been prescribed hydrocodone combination products in the past about the DEA’s decision to reclassify. Furthermore, they took the time to explain to our veterans the changes to the typical process that they will experience.

There are two aspects of the letter that really stick out. First, it explains the reasoning behind the DEA’s decision in a simple, yet alarming way – one I which my dad really took notice to. The letter states:

The DEA did this because these medications were found to be highly abused, habit forming, and potentially deadly in overdoses and need stricter regulations to improve their safe use.

Simple yet effective. It reads a lot like a surgeon general warning on a pack of cigarettes. The second impressive aspect of the letter is the fact that my dad hasn’t had a prescription for any drug that fits this category since his neck surgery 4 years ago. And so who knows how far back the VA went in considering which vets to send this letter to, and perhaps it was everyone who has ever received a hydrocodone combination product. Whatever they did, from my perspective it was above and beyond and so kudos to the Department of Veteran Affairs for stepping up and being proactive.

VA Letter on HC Products

The DEA Finally Decides To Reschedule Hydrocodone

August 27, 2014

Last week the DEA released a final rule on the rescheduling of hydrocodone removing it from the schedule III controlled substances list in favor of a schedule II designation. To be clear, this decision specifically addresses hydrocodone combination products (i.e., hydrocodone-acetaminophen formulations such as Vicodin) as hydrocodone by itself has always been a schedule II drug.

The new parameters surrounding the prescribing of hydrocodone under the more restrictive schedule II classification will go into effect on October 6, but the decision by the DEA in conjunction with the Assistant Secretary for Health of the U.S. Department of Health and Human Services has been a long time coming. Hydrocodone combination products (HCP’s) have been schedule III since the Controlled Substances Act was passed in 1970 despite, as mentioned, the fact that hydrocodone itself has always been a schedule II drug. The thought initially was that by combining hydrocodone with another substance such as acetaminophen would diminish the abuse potential, but in the DEA’s final order they actually point to several different statistics that definitively portray just the opposite. Perhaps the most eye opening of these statistics tells us that high school aged children have actually abused Vicodin at twice the rate of Oxycontin, a more tightly controlled schedule II drug that has in the past, grabbed a lot more of the headlines.

Not surprisingly, there was a lot of pushback from the pharmaceutical community as well as some from the medical community throughout this process which has taken 15 years to come to fruition (the original petition was submitted by a physician in 1999). This dissent however, is misplaced and perhaps even irresponsible considering hydrocodone is the most prescribed drug in the United States. Last I checked, heart disease was the biggest killer in this country, not pain, yet hydrocodone is prescribed more than even ACE inhibitors (for hypertension) or statin drugs (to lower cholesterol).  And if that is surprising to you try to wrap your head around this: the United States is comprised of about 4% of the world’s population yet we use 99% of the world’s hydrocodone.

The affect this will have on the workers compensation industry could prove to be significant. In terms of PBM’s who commonly push for mail order distribution, schedule II drugs have restrictive policies not conducive to this type of service. It would therefore be a good idea to check with your PBM to ensure that they are actively transitioning all applicable injured workers.

A second implication could be in regards to the widely utilized Official Disability Guidelines (ODG) which have long classified several HCP’s as Y drugs (recommended for first line treatment) within their workers compensation formulary. If changed to N drugs, those HCP’s would be subject to immediate utilization review in states such as Texas and Oklahoma that have instituted a closed formulary.

In my world of Medicare Secondary Payer compliance, it’s tough to say exactly where the effect of this rescheduling will be felt, but there are some trends that I hope we begin to see starting with less hydrocodone on MSA’s. It is easy to get caught up in cost drivers and how to mitigate unnecessary medical treatment in my line of work, and rightfully so when a prescription that was never meant to be maintained long term must be allocated for because it is part of the current treatment plan. But oftentimes, payers tend to overlook or not focus on HCP’s due to their relative low cost in comparison to some of their counterparts such as Oxycontin, Opana or Actiq. The result of that is we are consistently including long term use of hydrocodone-acetaminophen (for example) within MSA allocations in spite of the fact that no opioid has ever been recommended for long term use. This sort of tradeoff is unavoidable at times, but I will still hold out hope that the DEA’s most recent stance to reschedule hydrocodone combination products will prove to have a significant impact on the misuse and abuse of prescription painkillers, not just in our little world of work comp, but far reaching into our society as a whole.

NCCI Releases New Study on Effects of Obesity in Workers Comp

June 20, 2012

There is mounting evidence of obesity contributing to the cost of workers compensation. Longitudinal studies by Duke University of its own employees-and by Johns Hopkins University of employees of a multi-site U.S. aluminum manufacturing company-point to substantially higher odds of injury for workers in the highest obesity category. Further, a 2011 Gallup survey found that obese employees account for a disproportionately high number of missed workdays, thus causing a significant loss in economic output. Finally, earlier NCCI research of workers compensation claims found that claimants with a comorbidity code indicating obesity experience medical costs that are a multiple of what is observed for comparable non-obese claimants.

The study shows that, based on Temporary Total and Permanent Total indemnity benefit payments, the duration of obese claimants is more than five times the duration of non-obese claimants, after controlling for primary ICD-9 code, injury year, U.S. state, industry, gender, and age. When Permanent Partial benefits are counted toward indemnity benefit duration as well, this multiple climbs to more than six.

And if the statistics aren’t enough to encourage action, consider this….

Employee is a 54 yr old laborer working for a landscaping company.  He is 5’4″ tall and weighs 310 pounds.  In 2002, while walking on grass with a bucket of weeds, he tripped on a rock.   Injured worker treated conservatively for years for knee and back pain as he was too large for an MRI (even the open ones only take up to 300 pounds).  The doctors felt that the only option for treatment was knee replacement surgery, but injured worker was told his obesity precluded him from being a candidate – he needed to lose 100 pounds before surgery was feasible.

By 2004 injured worker was over 350 pounds and unable to work. Employer continued to pay both indemnity and medical.  At this point, employer authorized a weight loss program and also paid for gym membership and transport.  To be certain progress was being made, employer authorized surveillance.  Injured worker was photographed going to gym and sitting.

In February, 2011, injured worker had lapband surgery.  He lost 60 pounds in first 6  months  -at this point he is down to 250 lbs and  requires surgery to remove skin, but still 50 pounds to go before knee surgery can occur.

Injured worker is now 64 yrs old now, not able to work and still waiting for surgery…

This incredible story is also true, and one I’m sure many of us can repeat from our own experiences…. as we’ve all heard many times, “truth is stranger than fiction”.

As a Medicare Set Aside company, Tower MSA Partners is reminded everyday of the significant impact of obesity on future medical cost  (Duke University,”Obesity and Workers’ Compensation: Results from the Duke Health and Safety Surveillance System”, 2007,  lists mthe edical cost of obese patients as 6.8 times that of patients of recommended weight) .   We also see the impact of obesity on both the quality of life and the life expectancy of the Medicare beneficiary.  Taking it a step further, when one considers the strong relationship between high opioid narcotic use and the lifestyle changes that almost invaribly lead to obesity, we find yet another reason to work diligently to identify these combination triggers as early in the life of the claim as possible.

The free report is available from NCCI here: NCCI Study on Effect of Obesity in Workers Comp.