Tuesday, October 4, 2011

Failed Risk Transfer Policy



If there is a single lesson I would focus employers on in todays regulatory environment it is your disabilty benefit plan design actually does matter and needs to be integrated with your overall human resources practices to assure ADA exposure is mitigated via a fundamentally sound and well understood claim process that transfers risk.

It is common in this era to see self-funded and ASO Short Term Disability and salary continuance. The risk lends itself to self funding it is wholly predictable and high frequency, low indemnity in nature. But just because you choose to self fund the claim risk does not mean you have adequeately transferred all your exposure.

Consider Maxim Healthcare Services, Inc. who is now under a three year consent decree from the EEOC for enforcing a policy that requires employees to be unrestricted before returning to work. Many employers still take an all or nothing view of restrictions. In other words an employee must have no restrictions before returning to work. Such a policy clearly violates the Federal Law under ADA.

Lets look at the press release from the EEOC emphasis mine;

PRESS RELEASE


9-22-11
Maxim Healthcare Services Settles EEOC Disability Discrimination Suit

Maxim to Pay $160,000 to Estate of Former Employee
MINNEAPOLIS – The Equal Employment Opportunity Commission (EEOC) announced today that a federal court has approved a consent decree between the EEOC and Maxim Healthcare Services, Inc., which resolves the EEOC’s disability discrimination lawsuit against the company. The lawsuit, filed in U.S. District Court for the District of Minnesota, alleged that Maxim had failed to provide reasonable accommodations and ultimately discharged Anne Whitledge, director of clinical services, because she had brain cancer. The lawsuit is captioned, Equal Employment Opportunity Commission and Larry Williams as Trustee and Personal Representative of the Estate of Anne Marie Alderson Whitledge, decedent, v. Maxim Healthcare Services, Inc., Civil No. 10-03998 (JNE/JSM).
Under the decree, Maxim will pay $160,000 to Whitledge’s estate. In addition, Maxim agrees to conduct anti-discrimination training and monitor complaints in the Minneapolis facility, where Whitledge worked, as well as in the five other Maxim facilities that were under some of the same management. Specifically, the three-year decree provides that in those locations:
•Maxim is enjoined from discriminating based upon disability in violation of the ADA by not providing reasonable accommodations to persons desiring to return to work from disability leave.

•Maxim shall not engage in any form of retaliation against any person because such person has opposed any practice made unlawful under ADA, filed a discrimination charge under ADA, testified or participated in any manner in any investigation, proceeding, or hearing under that statute, or asserted any rights under this decree.

•Maxim is enjoined from failing or refusing to engage in the interactive process with applicants or employees who Maxim knows or should know, may require reasonable accommodation to perform the essential functions of the jobs for which they seek to return after medical leave.

Maxim is enjoined from maintaining any policy that requires an employee with a disability to be free from restrictions before returning to work after a medical leave of absence.

Maxim shall evaluate whether individuals seeking to return to work after a medical leave pose a direct threat to themselves or others based on objective evidence and information.

•Maxim will train all of its management personnel on the law against disability discrimination and will post a webinar training module on its online training system to train its external employees on their rights as employees to be free from discrimination and retaliation under the ADA. At the beginning of each training session held under this decree, Maxim’s highest-ranking executive-level employee at the facility shall introduce the outside trainer and state that Maxim takes its obligations under all EEO laws and prohibitions seriously. Also at this time, such official shall also state Maxim’s policy of non-retaliation for people who oppose acts made unlawful by federal EEO laws and people who participate in protected activity under federal EEO laws.

Maxim will maintain a record of its attempts to accommodate all employees with a disability who have been on a disability or medical leave who have notified Maxim that they are released to work with restrictions and will provide the EEOC with a copy of its accommodation reports on a semi-annual basis.

•Maxim shall send a letter of condolences to the children of Anne Whitledge.

“This was a heartbreaking case,” said John Hendrickson, regional attorney for the EEOC’s Chicago District. “Anne Whitledge battled cancer and lost the job she loved because of it. Ultimately, Anne lost her battle to cancer. The EEOC is proud that it helped her wage the battle against the fears and stereotypes that some employers maintain about the ability of people with cancer to perform their job.”
The EEOC’s litigation efforts were led by trial attorneys Laurie Vasichek, Nick Pladson, and Jessica Palmer-Denig of the EEOC’s Minneapolis Area Office, and supervised by Associate Regional Attorney Jean Kamp of the EEOC’s Chicago District Office. The EEOC’s Chicago District office is responsible for processing charges of discrimination, administrative enforcement, and the conduct of agency litigation in North Dakota, Minnesota, South Dakota, Wisconsin, Illinois and Iowa, with Area Offices in Milwaukee and Minneapolis.
The EEOC enforces federal laws prohibiting employment discrimination. Further information about the EEOC is available on its website at www.eeoc.gov.



Friday, September 30, 2011

Eagle Ford Shale

Mayan's had a sick humor which is something operators in South Texas's new Eagle Ford Shale might want to keep in mind as they send forth service workers. Violence is not new in Mexico and as its spreads north through a porous border it serves as a reminder that Back to The Future may also be true as you view the ritual executions now becoming commonplace in Mexico.

Don't show up with a knife at a gunfight. Do have serious security and safety procedures embedded with your personnel. Do have kidnapping and ransom coverage. Have some modicum of historical perspective and know that Texas Rangers are hard men for a reason.

Friday, April 15, 2011

Dear Uncle Sam


I absolutely despise big government. I have no respect for the political advocates who espouse the expansion of government. What network will soon air a biggest loser reality show for the elected official who most successfully wields a chain saw to spending on behalf of their constituents? Check the chain saw maybe somebody can borrow some  oridinance from the army to use on their budget one of the tracked vehicles that shoots explosives 1/4 mile to clear lethal minefields of government. My money is on Fox here. But I am hoping its C-SPAN in 2012 and Paul Ryan gets nightly face time. I hope Nancy Pelosi is ordered to fly coach like her constituents.

I started my business the old fashioned way from savings. Nobody gave me anything. At every turn government obstructs small business with regulation and chokes it with economic policy designed to create an uneven playing field for its bankers in big business. Small business is tapped for funding but we are all in reality just slaves fueling the Leviathan and Uncle Sam is always hungry. But know this Big Government today Americans who work for a living are targeting your destruction. We are getting involved politically and we are united in a belief you are rapidly outgrowing our ability to feed you and we are planning firebreaks to contain your growth regardless of the political winds. You will not turn our nation into a balkanized free for all where radical experimentation and social engineering on an unprecedented scale run rampant. Our children will not be saddled with your debt. We are coming for you. Soon. And there is going to be an arse whipping when we arrive.Yours.

Friday, March 11, 2011

Happy Friday



Hayes Carll is what I am kistening to these days.

Tuesday, March 8, 2011

Happy Mardi Gras

Everyone should see Mardi Gras once when they are young. Get your Mardi Gras on New Orleans.



Friday, March 4, 2011

PPACA:Clear As Mud

Ok the best discussion I have seen yet of the nondiscrimination provisions of PPACA are detailed below compliments of BenefitMall.com. You can read the source materials below or just take my simplified and nevertheless accurate summary that on a party line vote using reconciliation Democrats passed a stupid law that made many employer provided health plans subject to fines of up to $100 per employee per day until shortly before Christmas 2010 when no one was paying attention the IRS suspended enforcement to avoid the embarrasment of scorn by millions of American who would have lost coverage when their employers dropped it to avoid onerous IRS fines January 1 , 2011. It just goes On & On kind of like this video happy Friday Peeps and by the way does REK look like he could use an EAP? Look at those shades.



Section 2716 of the Patient Protection and Affordable Care Act (PPACA) contains a provision that applies the “non-discriminatory” requirements of Section 2716 of the Public Health Services Act (PHSA) [Section 105(h) of the Internal Revenue Code] to all non-grandfathered health plans issued on or after September 23, 2010. This provision prohibits health plans from discriminating in the way benefits or costs are allocated and shared among classes of employees.

The implementation of the nondiscrimination requirements continues to be delayed. On January 10, the Internal Revenue Service (IRS) issued Notice 2011-2, which states that compliance with PPACA is once again delayed for insured group health benefit plans until at least March 11.1

There is significant confusion surrounding the nondiscrimination requirements. The following information details the timeline of the attempts on the part of the federal regulators to clarify these issues.
Provision and Scope

SEC. 2716. PROHIBITION OF DISCRIMINATION BASED ON SALARY.
"(a) IN GENERAL – The plan sponsor of a group health plan (other than a self-insured plan) may not establish rules relating to the health insurance coverage eligibility (including continued eligibility) of any full-time employee under the terms of the plan that are based on the total hourly or annual salary of the employee or otherwise establish eligibility rules that have the effect of discriminating in favor of higher wage employees.2”

Generally, the regulations issued pursuant to Section 105(h) apply to employer-sponsored health benefit plans that cover premiums and expenses for qualified medical and other specialty plans.3 The recent amendments expand the nondiscrimination provisions to health benefit plans irrespective of whether they are fully-insured, self funded or medical reimbursement plans. Some types of plans are excluded from the new requirements, including “grandfathered” plans, government-sponsored health plans and limited benefit plans.
The “benefits” provided under the health plan must not discriminate in favor of highly compensated individuals. The health plan should incorporate several design features in order to be non-discriminatory. For example, plans should:
Establish parity in employee contributions for each benefit level

Preclude offering lower co-pays for highly compensated employees

Not impose different waiting periods

The employer sponsoring the health plan also must not discriminate in favor of highly compensated individuals in actual operation. For example, discrimination in operation could arise if a plan administrator approves certain claims for medical expenses under the utilization management process for highly compensated employees while denying them to lower compensated employees.
As the regulation is developed, the definition of terms such as “benefit” and “highly compensated” will continue to be addressed in the provision development.
Comments and Timelines

Currently, implementation of the anti-discrimination provision continues to be delayed due to several outstanding issues that need to be addressed. The Department of Treasury, along with the Departments of Labor (DOL) and Health and Human Services (HHS), has released a series of public notices to gain guidance on how to best implement this provision.
Notice one: IRS Bulletin 2010-634

The first notice to address Section 2716 was issued on May 17, 2010. “This notice invites public comments concerning the application of rules prohibiting insured group health plans from discriminating in favor of highly compensated individuals. The United States Department of Labor and the United States Department of Health and Human Services have reviewed this notice and have advised the Department of the Treasury and the Internal Revenue Service (IRS) that they agree with it.”
Previous Request for Comments
“The final regulations under section 105(h) of the Code, prohibiting discrimination in favor of highly compensated individuals under self-insured medical expense reimbursement plans, were issued in 1981. The Department of the Treasury and the IRS are considering issuing guidance on the extension, through section 2716 of the PHSA and new section 9815 of the Code, of the requirements of section 105(h)(2) to insured group health plans. The Department of the Treasury and the IRS request comments on what additional guidance relating to the application of section 105(h) (2) would be helpful with respect to insured group health plans.
Comment due: November 4, 2010
Notice two: IRS Bulletin 2011-15

The second notice to address Section 2716 was issued on December 22, 2010. Notice 2011-1 which states compliance with the nondiscrimination provisions of the PPACA are suspended for insured group health benefit plans until an undefined date.
Request for Comments
“Comments submitted in response to Notice 2010-63 maintained that, without regulations or other administrative guidance under Section 2716, plan sponsors are uncertain how to apply the nondiscrimination provisions. In addition to what is meant by rules 'similar to,' comments raised a number of other issues regarding the application of Section 2716. Comments suggested that guidance address the application of Section 2716 before plan years beginning in 2014 (when the State Exchanges, employer responsibility and penalty provisions, and related provisions take effect) and also in and after 2014. The Departments recognize that the guidance under Section 2716 must take into consideration the Exchange operations and individual and plan sponsor requirements that go into effect after 2013.”
Notice three: IRS Bulletin 2011-26

The IRS continued to delay the implementation of Section 2716. The agency reissued Notice 2011-1 on January 10, 2011 to gain additional guidance.
Additional Request for Comments
Notice 2011-1 asks 13 key questions that need to be address to successfully implement Section 2716:
The basis on which the determination of what constitutes non-discriminatory benefits under Section 105(h)(4) should be made and what is included in the term “benefits.” For example, is the rate of employer contributions toward the cost of coverage (or the required percentage or amount of employee contributions) or is the duration of an eligibility waiting period treated as a “benefit” that must be provided on a non-discriminatory basis?

The suggestion made in previous comments that the Departments have the authority to provide for an alternative method of compliance with Section 2716 that would involve only an availability of coverage test.

The application of Section 2716 to insured group health plans beginning in 2014 when the health insurance exchanges become operational and the employer responsibility provisions (Section 4980H of the Code), the premium tax credit (Section 36B of the Code), and the individual responsibility provisions (Section 5000A of the Code) and related Affordable Care Act provisions are effective.

The suggestion in previous comments that the non-discriminatory classification provision in Section 105(h)(3)(A)(iii) could be used as a basis to permit an insured health care plan to use a highly compensated employee definition in Section 414(q) of the Code for purposes of determining the plan’s non-discriminatory classification.

The suggestion in previous comments that the nondiscrimination standards should be applied separately to employers sponsoring insured group health plans in distinct geographic locations and on whether application of the standards on a geographic basis should be permissive or mandatory.

The suggestion in previous comments that the guidance should provide for “safe harbor” plan designs. Specifically, comments are requested on potential safe and unsafe harbor designs that are consistent with the substantive requirements of Section 105(h).

Whether employers should be permitted to aggregate different, but substantially similar, coverage options for purposes of Section 2716 and, if so, the basis upon which a “substantially similar” determination could be made.

The application of the nondiscrimination rules to “expatriate” and “inpatriate” coverage.

The application of the nondiscrimination rules to multiple employer plans.

The suggestion in previous comments that coverage provided to a “highly compensated individual” (as defined in Section 105(h)(5)) on an after-tax basis should be disregarded in applying Section 2716.

The treatment of employees who voluntarily waive employer coverage in favor of other coverage.

Potential transition rules following a merger, acquisition or other corporate transaction.

The application of the sanctions for noncompliance with Section 2716.

Comments due: March 11, 2011

Next Steps

To ensure the smooth implementation of Section 2716, the federal agencies reviewing comments have stated that the request for public comment and guidance is critical. Unfortunately, the anti-discrimination provisions, along with many other PPACA requirements, are difficult to implement due to limited or poor statutory language construction.
Comments are due on March 11, 2011 for Notice 2011-17, and analysis by HHS, DOL and the IRS will take place over the next few months. Karen Levin out of the Office of Division Counsel/Associate Chief Counsel (Tax Exempt and Government Entities) will be the main drafter of the next notice.

Wednesday, March 2, 2011

Monday, February 28, 2011

Class Warfare

At a time when the long term solvency of Social Security is very much in question it is revealing to shed a little light on one provision of PPACA which is publicized far to Little and that is The CLASS Act (Community Living Assistance Services and Support Act). Yes, it seems Obamacare included a voluntary taxpayer optional long term care program that owes its origins to Ted Kennedy.

Whats wrong with that you might ask? Well for starters the design more or less mirrors the group guaranteed issue approach to LTC which has failed miserably for over 20 years in the private sector to the point where John Hancock has exited the group market along with MetLife and anyone else with a board or stockholders because its simply not profitable. Not only is it not profitable it is financially unsustainable. Imagine a wave of baby boomers faced with financial ruin from outliving their bodies ability to perform acitivities of daily living like bathing, dressing, eating, and transferring. All they have to do is enroll and pay premiums for 5 years and be actively at work for 3 years and they can receive a cash LTC benefit. And hey, the premiums are only expected to be $123 per month! What a deal!  You see the exact benefits costs and program details are all being designed by the Secretary of Health and Human Services at this juncture. think we will see an LTC trust fund established like the SS Trust fund to keep Congress from spending the proceeds sorta like the SS Trust Fund?

But it gets better. Check out this "wisdom" from CBO emphasis mine;

Q: Are there any estimates now of what those premiums might be?


A: During the long course of the CLASS Act plan’s development, a number of estimates were made of the premiums that could be required for a financially sound plan. These estimates vary widely depending on the version of the law (which changed as it went through the legislative process) analyzed, the data and the assumptions used. Many commonly cited estimates reflect studies of much older versions of the CLASS Act. No analysis to date exactly matches the complete details of the CLASS plan that will be implemented, as these details have yet to be determined. As Congress debated the version of the CLASS Act that is now the law, the non-partisan Congressional Budget Office (the official “score-keeper”) provided estimates of average premiums. The Congressional Budget Office (CBO) estimated that average premiums would be $123/month (lower for younger people, higher for older people). Naturally, the CBO estimate included assumptions about some detailed elements of the program that might be different when the final plan is ultimately determined. In addition, the CBO assumed, among other things, that the CLASS Act plan would have relatively low enrollment, such as that found with private long-term care insurance.


To again use a parable from popular culture examine the picture above closely. This time its not a Baby Ruth. It is an actual turd. No amount of chlorine can sanitize a pool contaminated with feces. It must be drained and sanitized every time. Now notice what the CBO said about the CLASS risk pool in the 2nd to last sentence;the CLASS Act plan would have relatively low enrollment, such as that found with private long-term care insurance. I am certain CBO meant relatively low enrollment like group LTC on a guaranteed issue basis of the type that is not even marketed anymore due to adverse selection. Which means the pool will ultimately be a septic tank unfit to dip a toe into much less to swim in and every time the septic is collected the taxpayers get to replenish the pool with tax dollars in order to allow allow Americans to have access to LTC. There is not a reinsurer who would ever insure such a risk but there is on the other hand a Democratic Party in America who did on a party line reconciliation vote sign taxpayers up to insure the risk which is not voluntarily insurable on a guaranteed issue basis. And its means tested, so low income Americans get subsidized until every taxpayer is low income and then what?

I think CLASS is actually an acronym meaning Clueless Liberals Accessorizing Social Security. It is a mind numbing subsection of PPACA stupidity to be implemented by bureaucrats at HHS. This is not even what Pelosi meant when she said we would have to read the bill to know whats in it because the final regulations are not due until October 1. 2012. At a time when we have the President & DNC carefully orchestrating union protests over collective bargaining rights and historic Federal, State & Local deficits we now have a  law created by politicians with a cognitive deficit that will insure all Americans go broke. Tell me this is not the same logic that brought us to a broken Social Security system? Why would we expect a different result this time? Remember that one difinition of insanity is repeating the same behavior and expecting a different result. Yet every time feces goes into the pool its contaminated so just keep Bill Murray in mind and remember this time its not a Baby Ruth.

Thursday, February 24, 2011

Federalist View Of Wisconsin & National Politics Instructive

The Federalist No. 10


The Utility of the Union as a Safeguard Against Domestic Faction and Insurrection (continued)

Daily Advertiser

Thursday, November 22, 1787

[James Madison]

To the People of the State of New York:

AMONG the numerous advantages promised by a well constructed Union, none deserves to be more accurately developed than its tendency to break and control the violence of faction. The friend of popular governments never finds himself so much alarmed for their character and fate, as when he contemplates their propensity to this dangerous vice. He will not fail, therefore, to set a due value on any plan which, without violating the principles to which he is attached, provides a proper cure for it. The instability, injustice, and confusion introduced into the public councils, have, in truth, been the mortal diseases under which popular governments have everywhere perished; as they continue to be the favorite and fruitful topics from which the adversaries to liberty derive their most specious declamations. The valuable improvements made by the American constitutions on the popular models, both ancient and modern, cannot certainly be too much admired; but it would be an unwarrantable partiality, to contend that they have as effectually obviated the danger on this side, as was wished and expected. Complaints are everywhere heard from our most considerate and virtuous citizens, equally the friends of public and private faith, and of public and personal liberty, that our governments are too unstable, that the public good is disregarded in the conflicts of rival parties, and that measures are too often decided, not according to the rules of justice and the rights of the minor party, but by the superior force of an interested and overbearing majority. However anxiously we may wish that these complaints had no foundation, the evidence, of known facts will not permit us to deny that they are in some degree true. It will be found, indeed, on a candid review of our situation, that some of the distresses under which we labor have been erroneously charged on the operation of our governments; but it will be found, at the same time, that other causes will not alone account for many of our heaviest misfortunes; and, particularly, for that prevailing and increasing distrust of public engagements, and alarm for private rights, which are echoed from one end of the continent to the other. These must be chiefly, if not wholly, effects of the unsteadiness and injustice with which a factious spirit has tainted our public administrations.



So Let me translate that for those among you who have a problem understanding 18th century English uncorrupted by slang or Ebonics.
  • Lets start with the title The Utility of the Union as a Safeguard Against Domestic Faction and Insurrection .  In other words it is the Union, the Federal Government Madison is offering as a structural protection against the danger of Faction.  Today we could call either party  a faction, especially the unique coalition of Unions, Progressives and various assorted left wing nut jobs that control the modern Democratic party.
  • Political Parties are a "dangerous vice" causing mortal disease to governments historically. Keep in mind The Federalist Papers were written anonymously under the pseudonym "Publius" so the reference here is Rome where today the food may be great but the government, not so much, but I digress.
  • It would be an unforgivable oversight to pretend the Constitution would be expected to stand up in the face of  a partisan majority  imposing their their will on the Nation to the detriment of the common good. Things like passing health care reform by Reconciliation by a party line vote for example. Fairly sure Mr Madison would have considered the Obama care vote to be a modern example of political parties run amuck. The emergence of the tea party and the landslide midterms sweeping Republicans into power are an indication the people have grown weary of party politics.
  • The Wisconsin minority Democratic party left the building to allow time for the unions and the democratic party and even the Presidents campaign organization to marshall protesters and bus them in from neighboring states to march for the camera's.Bereft of the intellectual underpinnings to to have an intelligent debate on financial matters other state democratic minorities soon followed. The progressive logic is akin to your Dad saying "do as I say not as I do" when he cannot or will not explain something. Think of Michelle Obama preaching diet while her husband steals a smoke. By the way progressives are in the cannot group which is why they resort to emotion instead of reason and logic or principle.Expedience is the currency of faction.
  • The unsteadiness and injustice by which a factious spirit has invaded our government is clear each day in the electronic or print media. In 2009 the 912 Rallies had no coverage except on Fox and among bloggers like me.
  • In 2011 Governor Walker in Wisconsin is vilified and the protesters are all over the television,every night. In 2011 Twitter and Facebook play key roles for organizers in Tunisia and Egypt because they do not trust their state run media either.
  • Yesterday we were all treated to an announcement that the Obama administration would not enforce the Defense of Marriage Act as it was unconstitutional. Contrast that with the reaction to PPACA being declared unconstitutional when the adminsitration immediately declared implementation would be ongoing. 
  • Yesterday President Obama finally commented on the situation in Libya where Qaddafi has been killing thousands of Libyans for over a week to condemn the violence. Qaddafi who ordered PanAm 103 to be destroyed killing 270 people. Qaddafi who financed http://en.wikipedia.org/wiki/Black_September_(group)at the 1972 Olympics and the 1986 Berlin disco bombing that targeted American servicemen. So much for the bully pulpit. Recall that Reagan bombed Tripoli after the linkage to Qadafi but I digress we do not have a war on terror anymore. How could we have a war on terror when the President mobilizes his own campaign organization to protest in battleground 2012 states where Republican Governors and legislatures are trying to solve serious fiscal budget shortfalls that he completely ignored with his 2012 budget. I wonder what James Madison would think of such behavior?

Monday, February 21, 2011

Got EAP?


I was just a normal guy.


Life was just a nine to five.

With bills and pressure,

piled up to the sky.



She never asked,

'cause she knew I'd been,

hangin' with my wilder friends.

Lookin' for some other way to fly.



Three days straight was no big feat,

to get by on no food or sleep.

And crazy,

was becoming my new norm.



I'd pass out on the bedroom floor,

and sleep right through the calm before the storm.



[chorus]

My life was just an old routine.

Every day the same damn thing.

I couldn't even tell I was alive.

I tell you,

the high cost of livin',

ain't nothin' like the cost of livin' high.



That Southern Baptist parkin' lot,

was where I'd go to smoke my pot.

And sit there in my pick-up truck and pray.



Starin' at that giant cross,

just reminded me that I was lost.

And it just never seemed to point the way.



As soon as Jesus turned his back,

I'd find my way across the tracks.

Lookin' just to score another deal.



With my back up against that damn eight-ball,

I didn't have to think, or talk... or feel.



[chorus]



My whole life went through my head.

Layin' in that motel bed.

Watchin' as the cops kicked in the door.



I had a job and a piece of land.

My sweet wife was my best friend,

but I traded that for cocaine and a whore.



With my newfound sobriety,

I've got the time to sit and think...

Of all the things I had,

and threw away.



This prison is much colder than,

the one that I was locked up in...

Just yesterday.



[chorus]



I tell you,

the high cost of livin',

ain't nothin' like the cost of livin' high.



...just leave that stuff alone... (quietly during closing instrumental)

Why Employers Need 3rd Party Adjudication of Disability


Look at the Doctor using privacy laws as a basis for fraud. One doctor even points out this is what he does every day. If you rely on a doctors note as the basis for establishing a legitimate sick day or short term disability claim here is a little window into the culture which is created. For more check this prior post and this brief excerpt from my blog in 2007.

The International Foundation of Employee Benefit Plans recently completed a survey of their membership on Salary Continuation and Short Term Disability (STD) which you can find for free here.
The survey revealed that salary continuation/STD is the black hole of employee benefit plans in terms of quantifying cost and controlling utilization.
Reasons cited for the difficulty of quantifying cost and controlling utilization and effecting changes are;
1.Union Contracts

2.Employee perception of value (Did anyone explain the probability of disability and the impact on employees of a sickness or injury which prevents work?).

3.State Mandates like CA Paid leave (Huh?)

4.FMLA Integration ( the machine is so well oiled and automated it cannot be improved?)

5.Management Buy-in (Did anyone explain the facts and costs?)


6.Entitlement (getting warmer!)

7.A lenient culture that does not enforce return to work (getting hotter!)

8.Most of the plans are payroll matters not ERISA plans (red hot, since employer cannot enforce plan terms and win an ADA challenge since payroll plans are not bonafide employee benefit plans

Saturday, February 19, 2011

Some Perspective On Wisconsin

Is it not interesting that the Public sector is the last bastion in America for organized labor? Why is that? Could it be perhaps that several generations have watched all those great paying union jobs in the private sector move overseas where plenty of workers were perfectly willing to do the job for considerably less money? But you cannot really offshore education, law enforcement, fire fighting, etc.

 Yes Governor Walker is busting the union and he is doing so for the simple reason that all over the state of Wisconsin local governments will have the ability to tackle their own fiscal deficits.

Gov. Scott Walker on Friday rejected an offer from the head of the largest state workers union in which workers would give concession on benefits, but keep their collective bargaining rights.
"Doesn't work," Walker told Journal Sentinel reporters in his office Friday afternoon. "And the reason, having been a local government official, is we've got 72 counties, 424 school districts, over a thousand municpalities. And like every other state, or nearly every other state across the country, our budget is going to have cuts in aids to local governments."
Walker mentioned that states such as New York and California have had to cut billions in aid to schools.
"My goal all along has been... to give these folks, and I asked for this in the past, tools to control their own budgets. You've got to give them some flexibility."
Walker said that time and time again, collective bargaining issues "stood in the way of local governments and school districts being able to balance their budget."


Earlier Friday, Marty Beil, head of the Wisconsin State Employees Union, said his group would be willing to give in to Walker's demand for concessions on their benefits if the governor gave in on his bid to repeal nearly all bargaining rights for public worker unions



 The money involved is $360M out of a $4B budget shortfall. Most Americans already contribute double the 12.5% toward health insurance and 5.6% toward pensions that the union employees will wind up paying if Gov. Walker is . Ronald Reagan busted the Air Traffic Controllers union. Gov. Walkers point is a good one to the unions and it is simply that the fiscal problems being faced by the state are bigger than your bargaining agreement. Get over it. The world has changed. Is anyone really surprised that in ultra progressive Madison Wisconsin there would be protests in the streets? How many classes at University of Wisconsin got walks yesterday so they could support the proletariat? A bunch in the College Of Liberal Arts I imagine. I wonder how many of those kids will be able to find a job upon graduation in Wisconsin if they get what they want now.

Yet President Obama and the DNC support the unions. Unions are their constituents you see. They really could give a rats ass about the vast majority of Americans who are actually in the majority that elected a Republican majority in Wisconsin to do exactly what Gov Walker and the Republican legislator's have proposed. But ramming through ObamaCare using reconciliation was the right thing to do according to President Obama, Nancy Pelosi, Harry Reid and all the other progressive nutjobs. They want to use the fiscal crisis to advance cap and trade and immigration reform so they will have a constituency that represents roughly 55% of the US population that will pay no income taxes and be ever so loyal to their democratic masters. John Boehner sounds much more like an adult on the Wisconsin issue;

“I’m disappointed that instead of providing similar leadership from the White House, the president has chosen to attack leaders such as Gov. Walker, who are listening to the people and confronting problems that have been neglected for years at the expense of jobs and economic growth,” Boehner said in a statement. “I urge the president to order the DNC to suspend these tactics.”


Every single state in the U.S. faces similar budget shortfalls and the fight is spreading to Ohio, Michigan, Minnesota and other 2012 Battleground states. Jesse Jackson has even entered the fray. Given the fiscal problems our nation faces at the National, State and local level, the war in Afghanistan, The Middle East imploding why on earth would President Obama fixate on Wisconsin? Because he is a statist and the  Wisconsin crisis has revealed his true character as did his reactions to Egypt's revolution.

I am immensely proud of my children. They work hard at school and are focused on their Academics. When they were younger and they asked for items that were unaffordable I would consistently reply with my own question: What would Mick Jagger say? Invariably they would groan "You can't always get what you want". Hopefully Wisconsin will get what it needs as will other states. 2012 is going to be a brutal viscious election and if progressives continue to vilify good men doing what they were elected to do the map of america will be far redder than today. Progressives still have not figured out that not only do the federal & states not have any money neither do the ordinary people who are being taxxed to death.

Friday, February 18, 2011

The Tipping Point

America is at a crossroads. Yesterdays events in Madison Wisconsin made headlines as teachers unions protested a plan by Wisconsin's governor to eliminate collective bargaining for teachers for employee benefits and to contribute 12.5% toward the cost of their health insurance and 5.6% toward the cost of thier pensions. Minority Democrats fled the state to prevent a vote.In New Jersey Republican Governor Chris Christie has come under fire from public sector unions for his attempts to  raise the retirement age, eliminate the cost-of-living adjustment, increasing employee pension contributions, and rolling back a 9% pay increase.

At a time when his budget is DOA on capitol hill President Obama even opined on the Wisconsin situation as an assault on unions which incidently places his view of the situation in Wisconsin as completely in line with the NY Times Editorial page. The thing is both governor Christie and Walker are speaking the truth when they state the obvious fact that their states simply do not have the funds. Governor Christie said it well;

“Here’s the deal: I understand you’re angry, and I understand you’re frustrated, and I understand you feel deceived and betrayed.” And, he said, they were right: “For 20 years, governors have come into this room and lied to you, promised you benefits that they had no way of paying for, making promises they knew they couldn’t keep, and just hoping that they wouldn’t be the man or women left holding the bag. I understand why you feel angry and betrayed and deceived by those people. Here’s what I don’t understand. Why are you booing the first guy who came in here and told you the truth?”



So call this an intervention from an adult who fully understands the consequences for our nation if we continue to act like Greece and expect China to pay for our binge. The New York Times Editorial Board, many unions and certainly many cowardly politicians in both parties remind me of the crowd at at a Robert Earl Keen Concert. Thank God  some Governors are starting to act like designated drivers.

Friday, February 11, 2011

Coming to Newstand Near You

Have you Heard Our Government is planning a comic book to explain Health Care Reform to its citizens.

A new comic book to explain President Obama's health-care reform is coming! It's being written by Jonathan Gruber, the MIT economist behind many of the reform's concepts!
We're talking in exclamation points because we hope the comic book borrows from the over-exclamation of such hallowed comics as Rex Morgan, MD and Mary Worth!
OK, the new venture may not go that far, says a Pulse report in the Boston Herald, but the idea of a 2,400-page document being reduced to splashy-colored panels with captions ought to amuse -- no matter on which side of the aisle you sit.
Gruber promises lots of pictures and text. That's because it's a graphic novel, a long-form comic book. But that doesn't mean it's a novel-novel, as in fiction. Gruber says he'll be using facts to tell the tale.
It already has a catchy title: Health Care Reform: What It Is, Why It's Necessary, How It Works

Pretty sure (NSFW Satire in following links)  Robot Chicken may have some fun with this during Adult Swim but I digress. Psst here is my favorite comic about the constitution.

Thursday, February 10, 2011

Live From The Cook County Jail


Truth is somehow stranger than fiction. Hat tip to Jim McGovern who shared an excellent piece on FMLA from a very well done blog. It seems that one in five Cook County Sheriff's Office Employees and one in four Cook County Jail Employees miss work each day for an FMLA Event. Cook County Illinois includes Chicago Illinois hometown of our president and where former Obama Chief Of Staff Rahm Emanuel is running for Mayor. The thrill is definitely gone may appear in a campaign commercial in 2012 you heard it here first.

Thursday, January 27, 2011

Uh Oh


EBN has included the best discussion I have yet found on the non-discrimination provisions of PPACA relating to carveout's. Kudos to Vanessa Scott for getting it right.

The Internal Revenue Service recently issued Notice 2011-1 regarding the application of the nondiscrimination rules under Internal Revenue Code (Code) section 105(h) to non-grandfathered insured group health plans pursuant to the Patient Protection and Affordable Care Act.According to the Notice, the IRS will not require insured plans to comply with nondiscrimination rules until further guidance has been issued. Furthermore, to allow insured plans adequate time to comply with the rules, it is likely that future guidance will not apply until plan years beginning at some time after the date that the guidance is issued.


Thus, plan sponsors will not be required to pay excise taxes associated with noncompliance with the nondiscrimination requirements until then. The Notice also requested comments on a number of issues that may be addressed in future guidance.
I personally feel that every federal worker or citizen who exposes an instance where federal regulations lead to confusion, job loss, higher costs and havoc being wrought on the citizens should get a free uh oh! hat. The initiative would be privately funded of course lest we bankrupt the Treasury. By the time the superbowl was played the entire stadium could be filled with patriotic hats.

Wednesday, January 19, 2011

PPACA In The Real World

Queen Sheila was bucking for some sound bites today for the evening news. Evidently, in her reality, repealing ObamaCare will result in citizens dying. As if the whole POS was not adopted  rife with flaws on a party line vote which required the fixes to be passed using reconciliation, In that spirit let me add just a few real life repercussions of PPACA from the front lines where business people must live.

A client called today seeking assistance with finding a child only individual health insurance policy. Ju8st a responsible parent trying to make sure her child was covered with health insurance. It seems they had tried finding a policy online with no success. Both parents are covered at work but the cost for their child to be covered was prohibitive. Unfortunately, PPACA leaves many Americans without a market for individual major medical child only policy options since dependent children now must be covered with no pre-existing condition exclusion. Many elected not to offer policies which were guaranteed to lose money and since the mandates do not kick in until 2014 the risk pool will be contaminated prior to then and their stockholders and customers may not understand. So today many Americans find themselves with no access to inexpensive (relative to Group policies) individual health insurance on a child only basis. How many of them will die due to the self-serving liberal Democrats like Rep. Sheila Jackson Lee who voted for PPACA which left them without a viable child only market? Care to answer that Queen Sheila?

Then there is the group client who covers management with a major medical policy while providing non-management employees with a mini-medical policy for those in minimum wage jobs. Since the company is non-unionized, located in a right to work state, with owners who would have been very unlikely to contribute to democratic politicians, what are the odds HHS gives their limited medical plan a waiver? What are the odds the non-management personnel get a free mini-med in 2014?  I am sure there are some readers thinking well in 2014 they will have to pay or play so they will be required to either provide health care or pay the fine and that is true if the mandate proves to be constitutional, which is highly debatable. However, do the math for yourself its a simple calculation; Either you pay $2,000 per employee as a fine or you pay for $5,000 per employee to provide health insurance. Lets say you are retail business, how do you possibly choose the latter and stay in business? Can you answer that Queen Sheila?

And lets discuss the impact of passing a 40% payroll cost increase through to the public on our nation from an inflationary perspective in the middle of a recession? And PPACA is not a job-killer? Does no one in the Democratic Party take economics? Have you no common sense whatsoever Democrats? And by the way what is the client to do until 2014 since your precious PPACA has further eliminated all remaining markets for management only carve-outs in the group market Madam Congressman Lee? And by the way how many jobs did PPACA kill at Principal Financial Group & Humana when your ill-conceived carve-out killer passed? I heard a businessman today spell out he could either pay $140,000 in fines beginning in 2014 or $250,000 to provide health care or he could just shut down one location get below 50 employees and solve the whole problem until representatives with an ounce of common sense held majorities in the House and Senate. Which do you think he is leaning toward?

Its long past time for the American people to tell the Democratic Party to drop the crack pipe and pay attention. Stop Spending our freaking money! Stop helping us!  Your precious PPACA is killing jobs and restricting options today in the real world.  November elections were no accident. People all over the nation will contribute to the opponents of the embarrassing representatives like Sheila Hackson Lee who pontificate about matters like PPACA without any real understanding of the damage they have already brought to average American's. Unlike that nut job in AZ we will do so at the ballot box Queen Sheila you arrogant windbag,

Tuesday, January 18, 2011

States Warn of $2.5 Trillion Pension Shortfall

If you think you 401(k) is doing poorly take a peek at what state pensions look like in the US.

Wednesday, January 5, 2011

See Ya!