Claim Duration Research Articles

A Shoulder Care Pathway Reduces Claim Duration Among Workers With Shoulder Injuries: A Cohort Study

A Shoulder Care Pathway Reduces Claim Duration Among Workers With Shoulder Injuries: A Cohort Study

EXERCISE PHYSIOLOGIST-LED PAIN SCIENCE COACHING VIA TELEHEALTH IMPROVED PAIN AND FUNCTION IN LIFE INSURANCE CLAIMANTS: A PRAGMATIC COHORT STUDY

INTRODUCTION & AIMS Personal injury and illness compensation claimants are more likely to experience persistent pain and poorer clinical/vocational outcomes than non-compensated clients. Evidence supports the effectiveness of pain science coaching to help people understand and re-train their pain system. This consequently reduces pain intensity, improves function and quality of life. However, the effectiveness of telehealth-delivered, exercise physiologist-led pain science coaching is yet to be evaluated. This study aimed to determine the effectiveness of an accredited exercise physiologist-led pain science coaching intervention via telehealth in Australian life insurance claimants. METHODS This pragmatic cohort study included 1,275 claimants receiving a pain science coaching intervention supported by life insurance compensation. Ethics was approved via Deakin University Human Research Ethics Committee (2023-347). Outcome measures were pain intensity (11 item numerical pain rating scale, range: 0-10 points) and function (two 11-item patient-specific functional scale, range: 0-20 points). Linear mixed models determined within-group change over time. RESULTS Clients (female: 75%, male: 25%) had a mean (SD) age of 50 (10) years (range: 20-69 years) and claim duration of 2 (2) years (range: 0-20 years). Mean (SD) intervention duration was 10 (6) weeks (range: 3-41 weeks), financial cost was A$1,149 (A$202; range: A$510-A$2,040) and included 5 (1) hours (range: 2-11 hours) of pain science coaching. Following the intervention, pain intensity decreased 25% (estimated marginal mean change [95%CI]: -1.49 [-1.59, -1.40] points, P<0.001) and function increased 76% (4.41 [4.21, 4.62] points, P<0.001). Changes surpassed established clinically meaningful effect thresholds for pain intensity (1.17 points) and function (2.6 points). Client Net Promotor Score was +60 (Australian Healthcare Index benchmark ≥ +30) and 91% were satisfied with the intervention. CONCLUSION An exercise physiologist-led pain science coaching intervention resulted in clinically meaningful improvements in pain intensity and function in compensation claimants. Clients reported high satisfaction rates.

Impacts of unemployment benefit program on job search duration: Evidence from Indonesia

Purpose ― This study examines the impacts of the Unemployment Benefit Program (Jaminan Kehilangan Pekerjaan, JKP) on the duration of job search in Indonesia using internal data sourced from the Employment Social Security Administering Agency (Badan Penyelenggara Jaminan Sosial Tenaga Kerja, BPJS TK).Method ― The study employs the Regression Kinked Design (RKD) model and Ordinary Least Square (OLS) estimation method to analyze the data on laid-off workers who have received the JKP benefits.Findings ― The study finds that, on average, the JKP beneficiaries have a longer duration of job search than laid-off workers who do not receive benefits. An increase in the replacement rate of the JKP benefits is associated with an increased duration of both job search and benefit claims. The RKD plot indicates that a replacement rate lower than 45% may decrease the duration of benefit claims and job searches. Implication ― The study recommends that the government should consider two potential options: (1) maintaining the current level of monetary benefits that leads to a longer job search duration; in other words, the program management must continue providing benefits for the maximum duration offered (up to 6 months), or, (2) reducing the monetary benefits, if BPJS TK aims to reduce the job duration. The results may change if a more robust labor market information system is available.Originality ― This study represents the first attempt to investigate the impact of the Unemployment Benefit Program (JKP) on job search duration in Indonesia. It might also be important to enrich the existing literature on the impact of similar programs in developing countries and countries with large populations.

Quantifying Ruin Metrics in a Diffusion-Driven Erlang (2) Risk Model with Dependency Modeled using the Spearman Copula.

This paper focuses on the perturbation of an Erlang (2) risk model by a diffusion process, challenging the assumption of independence between claim amounts and inter claim durations. To account for a tail dependency structure, we introduce the Spearman copula, enabling the evaluation of Gerber-Shiu functions and ruin probabilities associated with this model. Our analysis delves into the Laplace transforms of the discounted penalty function and the probability of ruin. Towards the conclusion, explicit expressions are derived, accompanied by numerical examples illustrating ruin probabilities for individual claim sizes with exponential distributions.

Online ejaculation training programs promote non-evidence-based treatment of male sexual dysfunction.

Purposefully reducing the frequency of ejaculation, coined "semen retention", and the similar practice of "NoFap", have been popularized on social media. They are frequently accompanied by unsubstantiated claims of health benefits. Their increasing popularity has led to the emergence of online courses claiming to teach these techniques. The goal was to characterize the landscape of courses offering ejaculatory training. A systematic Google search was performed using terms related to ejaculation training to identify training programs. Information regarding instructor credentialing, type and duration of courses, costs, and claims of medical benefits were extracted. Eleven ejaculation training courses were identified with 10 instructors (two courses named the same coach). Costs varied from $5 to $147 per week or a $20 to $199 one-time payment. None of the course instructors claimed standardized credentials in the fields of medicine or mental health. Seven instructors (70%) solely cited their own personal experience as their qualifying credentials. Courses claimed to improve erectile dysfunction, premature ejaculation, porn addiction, sexual performance anxiety, testosterone levels, and/or depression. Ejaculation training programs are costly, readily available online, and provided by instructors with no medical background. Despite no scientific evidence, these courses claim to improve various aspects of men's health and can be potentially damaging financially, physically, and mentally to participants.

MP79-12 ONLINE EJACULATION TRAINING PROGRAMS PROMOTE NON-EVIDENCE-BASED TREATMENT OF MALE SEXUAL DYSFUNCTION

You have accessJournal of UrologyCME1 Apr 2023MP79-12 ONLINE EJACULATION TRAINING PROGRAMS PROMOTE NON-EVIDENCE-BASED TREATMENT OF MALE SEXUAL DYSFUNCTION Erin Jesse, Nicholas Sellke, Lisa A. Paz, Joshua A. Halpern, Nicole Prause, and Justin M. Dubin Erin JesseErin Jesse More articles by this author , Nicholas SellkeNicholas Sellke More articles by this author , Lisa A. PazLisa A. Paz More articles by this author , Joshua A. HalpernJoshua A. Halpern More articles by this author , Nicole PrauseNicole Prause More articles by this author , and Justin M. DubinJustin M. Dubin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003356.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The male practice of purposefully reducing the frequency of ejaculation, coined “semen retention”, and the similar practice of “NoFap”, have been popularized on social media [1]. Discussions are frequently accompanied by claims of improvement in male sexual function despite contrary data [2]. Unfortunately, commitment to these interventions has been associated with increased anxiety and distress [3]. Despite this several online courses claiming to teach these techniques have emerged. We aimed to identify online courses offering ejaculatory training and to characterize their programs. METHODS: A systematic Google search was performed using 10 terms related to ejaculation training. For each term, the first two result pages were reviewed. Websites offering any training program to reduce ejaculation frequency or promote abstinence, in exchange for monetary payment were included. Information regarding the disclosed instructor credentialing, type and duration of courses, costs, and claims of medical benefits were extracted. RESULTS: Ten websites and 11 courses were identified (Table 1). Courses included ejaculation training in the form of semen retention (45%), NoFap (27%), “ejaculatory choice” (9%), and “ejaculation control” (9%). Six courses (55%) provided self-guided modules, 3 programs (27%) consisted of 1-on-1 instruction, and 2 programs (18%) involved group sessions. Costs varied from $5 to $147 per week or a $20 to $197 onetime payment. None of the 10 course instructors claimed standardized credentials in the fields of medicine or mental health, and seven instructors (70%) solely cited their own personal experience as their qualifying credentials. Many courses claimed to improve erectile dysfunction (73%), premature ejaculation (64%), porn addiction (82%), sexual performance anxiety (27%), testosterone levels (18%), and/or depression (18%). CONCLUSIONS: Ejaculation training programs appear to be led primarily by instructors with no recognized qualifications and promote non-evidence-based techniques to alter male sexual function. Claims to treat medical and/or mental health conditions are frequently made. Such programs are readily available online, costly to participants, and potentially damaging. Increased awareness by physicians of such programs is necessary and may assist in patient counseling. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1145 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erin Jesse More articles by this author Nicholas Sellke More articles by this author Lisa A. Paz More articles by this author Joshua A. Halpern More articles by this author Nicole Prause More articles by this author Justin M. Dubin More articles by this author Expand All Advertisement PDF downloadLoading ...

Exploration of the Usual Care Pathway for Rotator Cuff Related Shoulder Pain in the Western Australian Workers' Compensation System.

Investigate components of care for rotator cuff related shoulder pain in workers' compensation in relation to claim outcomes (claim duration, total medical spend, total claim cost, return to work outcome). Engagement with (had care, time to care) four components of care (prescribed exercise, imaging, injections, surgery) were obtained from auditing 189 closed workers' compensation files. Associations were analysed between components of care and claim outcomes. 80% received prescribed exercise, 81% imaging, 42% injection and 35% surgery. Median time to imaging (11 days) was shorter than the prescribed exercise (27 days), with injection at 38 days and surgery 118.5 days. With univariable regression analysis higher age, the involvement of legal representation and the presence of rotator cuff pathology from diagnostic imaging (partial thickness tear or full thickness tear) were all associated with increased claim duration, total medical spend, total claim cost and less successful return to work outcomes. After adjusting for these three associations, having an injection or surgery were both positively associated with longer claim duration and greater medical spend, and surgery with greater total claim costs. In general, longer time to receiving components of care was associated with increased claim duration and reduced odds of returning to full duties at work. Early management was not consistent with clinical guidelines for managing workers' compensation rotator cuff related shoulder pain. This may negatively affect claims outcomes.

PERHITUNGAN MEDICAL REIMBURSTMENT PREMIUM DAN DAILY BENEFIT PREMIUM UNTUK SICKNESS INSURANCE

The purpose of this study is to calculate premiums for sickness insurance using Helligman Pollard's law of mortality. This research will focus on Medical Reimburstment Premium and Daily Benefit Premiums. Data on the size of claims, z (frequency of claims per individual) and d (duration of claims) where z has a Poisson distribution (0.8) and claims size is lognormally distributed (1,5,1). The premium calculation will be aggregated for 5 years and starting from the age of 15 years to 70 years. The premium for daily benefits is higher than the premium for medical reimbursement for all ages. The lowest premium is premium for 25-30 years old, which is 8.518657957 for medical reimbursement premium and 41.79084811 for daily benefit premium, while the highest premium is for 65-70 years old, which is 114.2254996 for medical reimbursement premium and 258.6346296 for daily benefit premiums.
 Keywords : Sickness Insurance, Premium, Medical Reimburstment, Daily Benefit

Relationship Analysis of Injured Workers' Average Weekly Wages and Workers' Compensation Indemnity Claims in Maine, US: 1998 to 2017.

Explore the relationship between injured workers' average weekly wages (AWW) and their workers' compensation (WC) claims outcomes in Maine, US. A total of 29,668 indemnity (lost-time) claims categorized into three wage-based percentile groups from a 20-year period (5-year intervals) were analyzed. WC outcomes included medical costs, number of indemnity checks, claim's duration, and claim settlements. Generally, claims within the lower percentile group were less likely to have high medical costs, but were more likely to have an elevated number of indemnity checks when compared to those in the middle percentile group. An inverse relationship was observed for those claims within the higher percentile group. Generalizations about low wage earners' claims being longer-lasting and more expensive or early return to work always reducing the medical cost of claims should be avoided.

Prevention, Medical Management, and Adjudication of Workplace Injuries: A Thirty-Two Year Follow-up of an Integrated Workers' Compensation Program.

Objective:To describe the cost outcomes of an integrated workers’ compensation program.Methods:We studied a population that increased from 20K to 59K, incurring 8807 lost-time claims between 1988 and 2020.Results:Lost-time claims decreased from 22.15 to 4.32 per 1000 employees (1988 to 2020), and total closed lost-time claim costs per $100 payroll, decreased from $0.62 to $0.17 (1988 to 2017). The percent of claims resolved within 3 years of the accident increased from 10% to 89% (1988 to 2017). Adjusting for medical inflation and wage increases, total workers’ compensation benefits paid per claim decreased $124 per year, medical benefits decreased $45 per year and indemnity benefits decreased $79 per year.Conclusion:On both a population (per employee) and on a per claim basis, workers’ compensation costs decreased substantially, which is attributable to improvements in accident prevention and decreases in claim duration.

Utilisation of exercise as part of guideline-based care for hip pain in the Australian workers’ compensation environment

Guidelines recommend early referral for exercise for hip pain. It is unclear if this occurs in the Australian workers' compensation environment. To investigate referral for exercise in workers with a compensable hip claim. Retrospective audit of closed compensation files for workers with hip pain was performed. Exercise commencement was indicated by billing codes for physiotherapy or exercise specific consultations. Time to exercise commencement was calculated. Associations were analysed between time to exercise commencement with claim duration and diagnostic category. Exercise management occurred for 33/44 cases. Median time to commence exercise for those cases that had exercise was 14 days post-injury, with 33% commencing beyond 4 weeks. Longer time to commence exercise was associated with a longer claim duration (Spearman's rho = 0.70). Workers with a diagnosis of hip joint pain had a longer time to exercise commencement (median 49.5 days) compared to those with a diagnosis of lateral hip pain (median 14 days) or non-specific hip pain (median 4.5 days). Findings indicate practice behaviours in the workers' compensation environment for the management of hip pain with exercise. Further investigation is warranted to see if improved adherence to guideline recommendations improves outcomes for people with compensable hip pain.

Earnings responses to disability insurance stringency

Accurate assessment of earnings capacity is critical to the efficient operation of disability insurance (DI) programs. We use administrative data on the universe of Dutch DI recipients to estimate employment and earnings responses to reassessment of their earnings capacity under more stringent rules. We estimate that reassessment of recipients aged 30–44 removed 17 percent from the program and reduced benefit income by 20 percent, on average. In response, employment increased by 6.7 percentage points and earnings rose by 18 percent. Recipients were able to increase earnings by € 636 for every € 1000 reduction in DI benefit. This earnings response was strongest from those with more subjectively defined disabilities and a shorter claim duration, as well as younger and female recipients.

Characteristics of National Malpractice Claims in Oral and Maxillofacial Surgery

Insight into the causes and outcomes of malpractice claims against surgeons will help inform practitioners and may support better patient care. The purpose of this study was to characterize national malpractice claims against oral and maxillofacial surgeons (OMSs). A comprehensive review of all claims against OMSs from 2000 to August 2018 in the National Practitioner Data Bank was performed. Primary outcomes were claims against OMSs, payment amount, claim duration, and percentage of anesthesia-related claims. Other variables of interest included demographic characteristics, nature of allegations, clinical outcome of injury, outcome of claim, and number of payments of $1 million or greater ("catastrophic payments").Student t tests and Wilcoxon rank-sum test were performed, and P<.05 was considered significant. This was a retrospective cohort study of malpractice claims against OMSs. There were 2,643 claims against OMSs during the study period. The average age of the claimant was 35.5±18.4years, and 47.6% were female patients. Most claims (94.7%) were settled out of court for a mean of $130,824±$402,633.8. Court-adjudicated claims had significantly higher payments with a mean of $247,554.69±$414,655.51 (P<.0001). The average duration from time of event to conclusion of claim was significantly shorter for settled claims (3.5±2.3years) than for claims that were court adjudicated (5.2±2.7years) (P<.0001).Anesthesia-related claims made up 3.63% of the total, and 0.56%of claims were pediatric anesthesia related. Anesthesia-related payments were significantly higher than other claims (P<.0001). The most common type of allegation was "surgery-related" injuries (63.1%), followed by "treatment-related" injuries (22.2%). The most common clinical outcome was minor permanent injury (34.6%). Most claims against OMSs were settled. Only a small portion of claims were associated with anesthesia complications, but payment amounts for these were significantly higher than for other claims. Settlements were made more quickly and for significantly lower rewards compared with judgments. Claims against OMSs during the past 2decades were most commonly associated with minor permanent injuries occurring in the outpatient setting.

Part II: Psychological Factors In Delayed And Failed Recovery and Unnecessary Disability

Abstract Part two of this two-part article on psychological factors in delayed and failed recovery and resultant unnecessary work disability (DFRUD) considers both conceptual and practical interventions, including specific evaluation and treatment methods. The authors propose five categories of intervention for DERUD: 1) advance and operationalize our knowledge base; 2) make conceptual and practical shifts in our approaches; 3) place greater emphasis on prevention; 4) improve recognition of potentially difficult cases, and 5) apply specific management approaches and tools. Further, the authors propose conceptual and practical changes that should be made: Eliminate the dualistic separation of mind and body and the scientific reductionism that follows; change the focus from disability to capability; reduce improper workers’ compensation claims; improve the administrative and medical management of valid claims; enhance collegiality and communication among all stakeholders; and adopt a cost-utility vs absolute cost approach. The overarching goals of managing DFRUD include optimizing administrative and clinical treatment of the worker; protecting all stakeholders from excess; and overcoming barriers to intervention. To these ends, three activities can optimize the process: Intervene early; avoid iatrogenicity (ie, shorten claim durations and reduce costs); and stratify risk and employ stepped care. Barriers to meaningful intervention in DFRUD include questions of jurisdiction and responsibility for management (eg, does management of DFRUD fall to insurers or clinicians); who will pay; what are the maladaptive health cognitions and/or psychiatric comorbidities; and how can clinician behavior be altered to implement evidence-based practice?

The resolution process and the timing of settlement of medical malpractice claims.

We draw on uniquely detailed micro-level data from a Belgian professional medical liability insurer to examine how different procedural and legal events that take place during the unfolding of a medical malpractice claim influence the timing of its settlement. Utilizing the competing risks regression framework, we find that settlement hazard is all else equal statistically significantly positively associated with the completion of those procedural and legal events that most effectively reveal factual information about the underlying medical malpractice case. Consistent with theory, settlement hazard is either unassociated or even negatively associated with the completion of other procedural and legal events. Our analysis, therefore, provides policy insights into which aspects of the resolution process could be emphasized, and which de-emphasized, in order to reduce the often excessive duration of medical malpractice claims and its adverse effects on the healthcare system.

Differences in Health: The Influence of Gender and Institutional Settings on Sickness Claims in Gothenburg, Sweden (1898-1950).

SummarySickness funds information has given conflicting evidence on the evolution of morbidity during the mortality decline. Evidence on increased morbidity has been explained by an actual increase of morbidity, a cultural inflation of morbidity or changing institutional settings, however, morbidity rates have also been shown to be stable over time when age composition of members is controlled for. Most previous studies have been confined to data on men; however, in an earlier article, Castenbrandt found large gender differences in historical sick leave by using national statistics on both men and women. To move forward, this article aims to analyse trends in sickness claims during the mortality decline in the early twentieth century using individual level data from Swedish sickness funds covering the period 1898–1950. Concretely, we investigate gender differences in sickness claims (incidence and duration) and how institutional settings (member composition and fund-specific regulations) affected the sick leave patterns.

Do Differences in Work Disability Duration Between Men and Women Vary by Province in Canada?

Purpose Research has shown that there are important sex and gender-based differences in the work disability duration of men and women. This research is often limited to single jurisdictions, using different outcome measures, and therefore has limited generalisability of findings. This study examined if differences between work disability of men and women differed by province and by duration of work disability. Methods Cohorts of injured workers in the Canadian provinces of British Columbia (BC), Manitoba (MB) and Ontario (ON) were analysed using workers’ compensation data for work-related injuries occurring between 2007 and 2011. Work disability duration was measured using cumulative days in receipt of disability benefits paid during one-year post-injury. Poisson models with restricted cubic splines tested whether differences between men and women in the likelihood of transitioning off disability benefits varied by duration of work disability in each province, adjusting for confounders. Results Men transitioned off disability benefits faster than women for claim durations of up to two to four months, after which women transitioned off disability benefits faster until ten months. Differences between men and women were consistent across all jurisdictions. For claims longer than ten months, men transitioned off work disability benefits faster than women in BC and ON, but there were no significant differences between men and women in MB. Conclusions Differences in the work disability duration between men and women vary by province and duration of work disability. Claims management processes need to be sensitive to differences that men and women face and the timing of interventions.

Early Identification of Potential SSDI Entrants in California: The Predictive Value of State Disability Insurance and Workers' Compensation Claims.

Purpose Examine the potential for using information in short-term disability claims to identify workers at high risk of leaving the workforce and entering Social Security Disability Insurance (SSDI). Methods We analyze state-wide California data on claimants of State Disability Insurance (SDI) and Workers' Compensation (WC) and present statistics on: (1) characteristics (primary diagnosis, sex, age, geography, wage level) by claim duration (0-3, 4-6, 7-12, 12 +months); and (2) the ability of initial claim characteristics to predict duration of at least 12months. All data are for claims with disability lasting more than 1week. Results 22.2% of SDI claims last longer than 6months and 12.5% last 12months. More WC claims reach these durations: 33.7 and 18.6%, respectively. Long-term SDI and WC claimants are similar to SSDI awardees, nationwide, but differ in age distribution; they are typically younger. Conclusions Characteristics of SDI and WC claims can help predict claims likely to last 12months, but more information is needed to effectively target early intervention services. Waiting longer to intervene improves targeting but risks missing opportunities where early intervention could be more effective. Collecting additional information at SDI or WC entry or soon thereafter could improve both the efficiency and timing of interventions.

Characteristics of individuals receiving disability benefits in the Netherlands and predictors of leaving the disability benefit scheme: a retrospective cohort study with five-year follow-up

BackgroundToday, work disability is one of the greatest social and labour market challenges for policy makers in most OECD countries, where on average, about 6% of the working-age population relies on disability benefits. Understanding of factors associated with long-term work disability may be helpful to identify groups of individuals at risk for disability benefit entitlement or continuing eligibility, and to develop effective interventions for these groups. The purpose of this study is to provide insight into the main diagnoses of workers who qualify for disability benefits and how these diagnoses differ in age, gender and education. Using a five-year follow-up, we examined the duration of disability benefits and how durations differ among individuals with various characteristics.MethodsWe performed a cohort study of 31,733 individuals receiving disability benefits from the Dutch Social Security Institute (SSI) with a five-year follow-up. Data were collected from SSI databases. Information about disorders was assessed by an insurance physician upon benefit application. These data were used to test for significant relationships among socio-demographics, main diagnoses and comorbidity, and disability benefit entitlement and continuing eligibility.ResultsMental disorders were the most frequent diagnosis for individuals claiming work disability. Diagnoses differed among age groups and education categories. Mental disorders were the main diagnosis for work disability for younger and more highly educated individuals, and physical disorders (generally musculoskeletal, cardiovascular and cancer) were the main diagnosis for older and less educated individuals. In 82% of the claims, the duration of disability benefit was five years or more after approval. Outflow was lowest for individuals with (multiple) mental disorders and those with comorbidity of mental and physical disorders, and highest for individuals with (multiple) physical disorders.ConclusionsThe main diagnosis for persons entitled to disability benefits was mental health problems, especially for young women. In a five-year follow-up, claim duration for disability benefits was long lasting for most claimants.

Precision Matters in Behavioral Health, Too

Abstract Behavioral health terminology is an area beset by imprecision that results from confusing claim determinations, unnecessary evaluations, and poor outcomes that result from inappropriate treatment. In medical evaluation reports, one notes references to depression, anxiety, and stress, which are not diagnoses but often are treated as such. Behavioral factors can affect claims in four ways: the presence of a formal clinical diagnosis that meets specific criteria, psychological symptoms, difficult life circumstances, and behavioral overlays. Only the first of these can be attributed to a workplace injury or illness, and determining a causal relationship requires, at minimum, a precise diagnosis. For example, by depression does the health provider mean major depressive disorder with specifiers, persistent depressive/dysthymic disorder, adjustment disorder with depressed mood, or some other specific condition? The behavioral layers can affect the outcome of the claims process and may or may not be appropriate targets of an evidence-informed intervention aimed at returning an injured or ill worker to a higher level of function. The point is not to argue whether or not behavioral interventions are appropriate in workers’ compensation, personal injury, and other claims; the point, rather, is that precise language is the first, necessary step in sorting out the myriad ways in which behavior affects claim incidence, duration, and cost.