Category Archives: Wellness

US States Ranked by Well-Being: A Strategy for Implementing Medical Tourism into Workers’ Comp

My good friend, and maybe yours too, Maria Todd, sent me an article this afternoon from

The article, “State of the State’s Well-Beings”, by Kelia Scott, discussed a recently released survey from Gallop-Healthways called the 2014 State Well-Being Rankings. These rankings determine how each state is ranked in terms of well-being.

Gallop-Healthways conducted over 176,000 interviews with adults in all fifty states, and asked them to rank elements that are related to well-being like social (having support and relationships), physical (good health and daily energy), environmental (liking your community and feeling safe), financial (managing your finances to reduce stress and insecurity) and purpose (liking what you do and feeling motivated).

The findings, which can be seen in greater detail here and here as well, indicated that high rates of well-being correspond to rates of healthcare utilization, workplace performance and absenteeism, a change in obesity rates and others. In short, healthier workers may be happier workers.

The map below indicates which states are in the top quintile, the 2nd quintile, the 3rd quintile, the 4th quintile and the bottom quintile.



So the strategy I would recommend for anyone wishing to implement medical tourism into workers’ comp would be to consider directing your energies and resources to the following states: Michigan, Indiana, Ohio, West Virginia, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, and Missouri. This would be followed by those states in the 4th and 3rd quintiles.

A personal note: I know that all of you in the medical tourism industry are sending good wishes for a speedy recovery to Maria as she recuperates from her recent illness, as I am, and that she will be back to good health as soon as possible.


I am willing to work with any broker, carrier, or employer willing to save money, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with and follow me on LinkedIn and my blog. Share this article, or leave a comment below.


Court Rules Obesity a Disability: What It Means for Medical Tourism and Workers’ Compensation

The Wall Street Journal reported yesterday that a Federal district court had ruled last week that obesity, by itself, may be a disability, separate from an underlying physiological condition. This confirmed an earlier article in the Wall Street Journal last month that discussed the rising risk of lawsuits on grounds of obesity discrimination.

In an article written by Gregory J. Millman, a senior columnist for Risk & Compliance Journal, and the author of last month’s article, Judge Stephen N. Limbaugh, Jr. (wonder if he’s related to you-know-who), a judge in the U.S. District Court, plaintiff Joseph Whittaker sued his employer on the grounds that his employer had “terminated his employment because of his disability and in retaliation for the charge of discrimination, threatened to terminate business with other entities if those entities employ plaintiff.”

Attorneys for the employer moved to dismiss the case, citing that obesity was not a disability under the Americans with Disabilities ACT (ADA), and they cited language from the Equal Employment Opportunity Commission (EEOC), that “except in rare circumstances, obesity is not considered a disabling impairment.”

Judge Limbaugh rejected that argument, and noted that it rested on case law that applied before the Americans with Disabilities Act Amendments Act of 2008 (ADAAA), which “rejected the unduly restrictive approach” to determining whether a plaintiff suffered from a disability. Judge Limbaugh also pointed out that the EEOC’s language had been “omitted following the ADAAA.”

The case is still in litigation, but an attorney who represents employers in labor and employment cases said that “I think we will see a lot more cases like this over the next few years.” The attorney also said “that employers should probably assume that obesity, at least severe obesity, constitutes a disability regardless of whether there is an underlying physiological condition involved, and seek a reasonable accommodation if the disability interferes with job performance.”

Corporate Wellness is one of the hottest areas of health care today, given the alarming increase in obesity among the American population. Related diseases such as High Blood Pressure, Diabetes, and Kidney Disease are something all employers need to address if some of their employees are obese.

This case, and many others like it, would suggest that rather than terminating an obese employee, employers would be better served if they kept the employee working and tried to get them appropriate medical care from a corporate wellness program. This would have a tremendous effect on the company’s health care costs, and on the employee’s self-esteem, knowing that his or her employer is looking out for their health, rather than firing them for having a disability.

In my White Paper, I discussed a case in California, in which an obese employee of a convalescent home, who fell while working as a cook, went to the Duke University clinic to lose weight. A friend had suggested he go there after his doctor and two of the employer’s doctors recommended that he lose weight. But as the employer did not direct the employee to a specific weight-loss program, the employee was free to choose he wanted to go. The Supreme Court of CA ruled in favor of the employee. (For a discussion on choice of medical provider see my posts, Employee vs Employer Choice of Physician: How best to Incorporate Medical Tourism into Workers’ Compensation  and Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation).

What does this mean for Medical Tourism?

The case in Missouri described in Gregory Millman’s article, and many others that will undoubtedly follow, presents a great opportunity for the medical tourism to capitalize on the corporate wellness programs employers might consider offering their obese employees as an alternative to expensive lawsuits stemming from wrongful termination because of a disability.

This was apparent to me when I attended the Medical Tourism Association’s 5th World Medical Tourism & Global Healthcare Congress in October of 2012. Executives from American Express and Google conducted a fireside chat on the topic of innovations in global benefits and employee wellness. Other companies such as Colgate-Palmolive, Cigna, and Disney made presentations there.

Weight-loss surgeries such as gastric bypass surgery and gastric sleeve surgery are areas where medical tourism can be of tremendous value to employers with obese employees. If those employees are part of a corporate wellness program, and have been unsuccessful in losing weight through diet and exercise, may be willing to undergo surgery to lose weight.

Ruling obesity a disability will mean more of these surgeries will be performed, and with more Americans getting health care through the ACA, medical tourism destinations will be one way in which those surgeries can be obtained by employers willing to pay for their employees to have surgery. The lower cost and higher quality of care in many destinations in the Western Hemisphere region will be a further enticement to employers looking to retain these employees and avoiding lawsuits over discrimination.

What this means for Workers’ Compensation?

That a Federal judge has made a preliminary ruling in a case of employment discrimination will have serious repercussions for the workers’ compensation industry, because if this case decides that obesity is a disability, many obese workers’ compensation claimants will file claims for workers’ compensation benefits citing their work environment as a contributing cause of their obesity. That would add significant costs to the initial claim, whether from a slip and fall or some other cause of injury.

While this may take many years to work its way through the courts and through workers’ compensation boards and other entities, employers would be wise to be proactive and incorporate a wellness program in their companies, so that obese employees can lose weight through diet and exercise, or baring that course of action, get surgery to lose the weight. Workers’ compensation carriers should also consider corporate wellness as a means to prevent workers’ compensation claims from expanding beyond the initial cause of injury,

The same constraints to getting surgery mentioned above would also apply to workers’ compensation claims, if obesity is considered a compensable medical condition. Anyone worried about what effect obesity as a disability will have on workers’ compensation claims, should be willing to consider alternatives to long, drawn-out lawsuits, workers’ compensation hearings and court cases, and charges of wrongful termination because of obesity. Medical tourism could be a viable option.

Can Medical Tourism Relieve Stress in Workers’ Comp?


That was the first thing that popped in my mind this afternoon when I read about a study in Australia that was first published in JAMA Psychiatry last week. That study, Relationship Between Stressfulness of Claiming for Injury Compensation and Long-term Recovery A Prospective Cohort Study, by Grant, O’Donnell, Spittal, Creamer, & Studdert was the subject of an article by Kathryn Doyle in Reuters Health. Robert Wilson was the person who brought the study to my attention when I received his “Bob’s Cluttered Desk” blog on’s Daily Report in my email this afternoon.

Both Doyle and Wilson’s articles, Stress of filing injury claims linked to poorer health later and Does Claims Stress Increase Disability? states that researchers at Stanford University found that the stress of filing a claim for an injury may actually increase the severity of the disability over the long term. A survey of accident victims found that stress often comes from confusion over the process, delays and related medical assessments. The researchers found, it was reported, that those who “were most stressed by filing a claim tended to have higher levels of disability years later”.

Doyle and Wilson both quoted David M. Studdert of Stanford as saying that, “The novelty of this study was to look within a group of claimants to test whether those who reported experiencing the most stress also had the slowest recoveries”. The researchers found they did, according to Studdert.

“A random selection of more than 1,000 patients hospitalized in Australia for injuries between 2004 and 2006. Six years later, 332 of the patients who had filed for workers’ compensation or another accident claim told the researchers how stressful the process had been.”

A third of the claimants, the study found, reported high stress form understanding the claims process and another third were stressed by delays in that process. A slightly smaller proportion, the study said, said repeated medical evaluations and concern for the amount of money they would receive were sources of stress.

Studdert and his fellow researchers made the point of recommending that programs such as workers’ compensation could be redesigned to respond faster and make it easier for patients to understand. I am relatively sure that had this study been conducted in the US, and with a cohort of native-born and foreign-born workers, the results might be somewhat the same. It is why I have repeatedly said in previous posts that having workers treated in home country or similar facilities where the language and culture are the same or nearly the same, would not only relieve much of the stress of filing a claim, but with dealing with the stress of surgery and recovery.

Doyle reported that negative attitudes from doctors, friends, family or colleagues, did not seem to be common sources of stress. People with the most stress tended to score higher on a disability scale and have higher levels of anxiety and depression, as well as lower quality of life, Doyle said the researchers reported in the JAMA Psychiatry paper.

David Studdert even said that, “While it’s intuitive that the compensation process is going to be stressful for some claimants, what is less clear is whether that stress has a substantial impact on recovery many years after the injury.” Studdert also said, “We were surprised by the size of the compensation effects on outcomes like level of disability and quality of life – they were fairly strong.”

Doyle also wrote that the researchers took into account that some patients seemed to be more vulnerable to stress from the start, they found that the link between claim stress and long-term recovery as similar but not as strong. Michele Sterling, who studies injuries and rehabilitation at the University of Queensland in Herston, Australia said, “There is much debate at the moment about the role of ‘systems,’ in this case ‘compensation systems’ on health outcomes. She was not involved with the study conducted by Stanford University.

Sterling went on to add that, “If it can be established which parts of the process causes stress and/or poor outcomes or recovery then the system could look at targeting these specific areas and improve them”. Finally, Sterling told Reuters Health that “Some insurance regulators are already trying to do this in some areas.”

It is interesting to note here that the study deals with severe injuries that required hospitalization. Whether they required surgery is not clear, but is probable. This is probably where medical tourism can play a role, because if the surgery is performed in a facility that treats medical tourism patients, and recovery can be made in serene and restful surroundings, then the level of stress of the patient would be that much more reduced, even if the process of filing a claim and going through the claims process is still stressful. That would certainly be true for patients suffering through harsh winters like the ones we are experiencing in much of the US this winter.

Robert Wilson’s take on this study is also interesting, at least to myself, since I was once involved with workers’ comp claims, and Auto No-Fault claims, and it was while I handled No-Fault claims that I encountered a claimant who exhibited extreme stress from having an accident with his limousine, which my company insured for Automobile insurance at the time.

This gentleman was from Egypt and was a Coptic Christian, whose job driving executives and business people in what are called, ‘black cars’, must have been stressful enough having to negotiate Manhattan traffic and hurried professionals. The fact that the accident occurred and he was unable to work as a result of it, caused him more stress, and by the time he came to our office to be examined by our medical expert, he broke down in tears right in front of my eyes.

Now I am someone who never wants to see anyone cry when they are hurt and cannot work, so before he saw our doctor, I spoke to the doctor and told him about this man. I appealed to the doctor out of human decency and out of our shared cultural heritage of caring for those who are suffering, since our culture has suffered a lot in our long history, but that is for another blogger to discuss. I cannot recall what the outcome of this man’s case was, as it was a long time ago, but I do hope that he found some solace in knowing that there were good people trying to help him.

Back to Robert Wilson.

Wilson was struck by the finding of the study where the respondents said that, “repeated medical evaluations and concern for the amount of money they would receive [Emphasis added by Wilson] were sources of stress.” Wilson reiterated something he has said many times, that people rarely ask how they can get better, but rather how much they will make.

Wilson believes that the system is not and was never designed to fully meet that goal. He says that the workers’ compensation industry needs a new identity and a focus on Return to Function. Some of the prescriptions he recommends are:

  • Changing the name of Workers’ Compensation to Workers’ Recovery, where recovery specialists would work with workers with the goal of restoring whatever function was possible to their lives.
  • Better communication, more clear explanations, and increased expectations for recovery can be instilled to those coming into the system

Finally, Wilson quoted from the source article about the study from Katherine Lippel, of the University of Ottawa , where she studies occupational health and safety law. Lippel said, “I think the point that needs to be made is that those managing these systems, insurers of workers’ compensation boards, or no-fault automobile compensation schemes, should realize that they are undermining their own mission of getting workers back on their feet if the process is unnecessarily stressful.”

Medical tourism cannot make the process of filing a claim or the claims process itself less stressful; that is the responsibility of the industry itself, the regulators of the system and the insurance companies that write the policies or the Third Party Administrators who handled the claims for the insurers or employers. What medical tourism can do, and should do, is to make the final stage of the claims process, surgery and recovery, as stress-less as possible, and to return the injured worker to a state of health similar to what they experienced before their injury. This would serve the medical tourism well and would win it many more supporters and more repeat customers.


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Health Care Integration

This article ties in very nicely with one of my earlier posts, A ‘Case Study’ in Implementing Medical Tourism into Workers’ Compensation, available here: