Experts here warned that workers' compensation systems faceimpacts from a variety of factors, ranging from bed bugs and Iraqwar injuries to beryllium dust and language difficulties.

The coming challenges were outlined at a session of the Workers'Compensation Educational Conference by Jennifer Tomlin, senior vicepresident at Zurich North America, and Robert P. Hartwig, seniorvice president and chief economist at the Insurance InformationInstitute. The session was one of seven on national trends put onby The National Underwriter Company as part of its partnership withthe Florida Workers' Compensation Institute, which runs the WCECprogram.

In addition to the injury causes already resulting in claims,they also issued cautions about nanotechnology and bird flu.

Mr. Hartwig said avian flu would be a cause of comp claims fromhealth care workers and that if a major epidemic were to hit theUnited States, the number of comp claims would be "potentiallymillions."

On another front, he noted statistics showing that workers withlimited English and education face a high risk of injury. Latinos,he said, are 60 percent more likely to be killed on the job thanother workers.

Communication errors lead to occupational injuries and death,Mr. Hartwig said, adding that with 35.1 million people between theages of 18 and 64 who don't speak English at home--9.68 percent ofthe U.S. population--language barriers on the job are a "powder kegfor injury."

Mr. Hartwig also spoke, as he has in the past, of the impact ofIraq war veterans returning to the job, noting that 40 percent ofthe troops serving in that theatre are National Guard or reservistswho will be returning to the workplace. The vast majority willreintegrate without problem, but currently 30 percent of allreturning troops are exhibiting some form of mental healthproblems, he said.

In addition, many have undiagnosed injuries including traumaticbrain injuries resulting from exposure to the concussion ofimprovised explosive devices.

Other factors that could lead to comp injury severity orfrequency include post-traumatic stress disorder and relateddepression, sleep deprivation, substance abuse and socialmaladjustment. He suggested returning vets need monitoring instressful jobs and those involving heavy equipment and driving.

Zurich North America's Ms. Tomlin said the metal powderberyllium, which is used in dental labs and in products such astelevisions, X-rays, mirrors, springs, calculators and computers,could impact 10,000 employer locations and 48,000 employees.

Another injury causation factor she revealed was the stress tohotel housekeepers who must change 500 pounds of linen a day onking-sized beds. Such workers, she said, face a disability injuryrate 51 percent higher than for other service sector workers.

Bed bugs, she said, are a hazard that can injure workers inhotels, theatres, dormitories and apartments, and can cause skinswellings, irritation and itching that can lead to infection and"cause anxiety and mental anguish."

Ms. Tomlin also noted the danger of chronic, disabling andsometimes fatal injury from silica dust--a substance that at least1.7 million workers are exposed to.

In the unknown comp injury category, Ms. Tomlin placed the25,000 workers currently laboring in the field of nanotechnology,the manufacture of items with matter the size of a billionth of ameter.

At this point, she said, it is undetermined what the effectsmight be from exposures in that industry.

At a separate session, Mr. Hartwig was one of several expertsassessing the comp insurance industry, who said the sector isshowing continuing improvement even as worries persist overterrorism and medical costs. He noted that workers' comp had a 7.9percent rate of return last year and its combined ratio was 90 forthe accident year and 102 for the calendar year--a vast improvementfor a sector that in 2001 had a calendar-year combined ratio of122.

The line, he opined, was "very profitable indeed."

The p-c sector overall, he said, had its combined ratio helpedby workers' comp. This year, the p-c industry overall should seeits combined ratio end at 97 or perhaps even better, hepredicted.

While lost-time claims frequency was down 4.5 percent last year,medical costs have continued to climb, he said. Since 1985, themedical share of comp claim payments has grown from 44 percent to58 percent, and Mr. Hartwig forecast it will hit 75 percent in fiveor six years.

Susan Doyle, Wausau Insurance executive vice president andgeneral field operations manager, said the medical cost issue "goeswell beyond workers' compensation."

"This is an overall health care issue and we will be sweptalong." Comp insurers, she said, should work to "stimulate movementto improve the overall health care situation."

John Santulli, PMA Insurance Group senior vice president formarketing and field operations, listed tools that comp insurers canuse to keep costs down: getting accident reports in on a timelybasis, checking the effectiveness of network treatment systems,working to control prescription plan costs, and preventingimproperly upcoded provider bills.

Unless the comp system puts more controls on health treatmentutilization, there will be more acceleration in medical costs, headded.

Vern Steiner, CNA vice president for workers' compensationclaims, said while claimant fraud has not increased there are nowmore attempts to tie all a worker's ailments "to work-relatedwoes."

Mr. Steiner also voiced a concern that as more states instituteutilization controls there could be the kind of reaction that hasbeen seen against health maintenance organizations, restrictingtreatments.

Medical treatment, he said, "isn't black and white," and ifutilization controls are too restrictive there could be "a publicbacklash and reforms might be undone."

Mr. Hartwig also voiced alarm over how comp insurers will fareif the Terrorism Risk Insurance Act is allowed to expire in2007.

The way to lobby the issue, he said, is to involve local Chamberof Commerce members. At this point, however, he said local businesspeople are not thinking about this. "Hardly a neuron fires on theTRIA issue," he said.

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