Employment Claims Research Articles

A Resource-based View of Corporate Social Irresponsibility: Evidence from Shareholder Value Destruction in China

Following stakeholder resource-based view (SRBV), we conceptualize the value relevance of corporate social irresponsibility (CSI) based on the bargaining power of stakeholders’ economic claims over firms’ inputs and revenue generations, and classify the stakeholders into residual claimants (i.e. customers, shareholders) and fixed claimants (i.e. employees, environment). Using a curated detailed news data of 816 CSI episodes and 56,503 Chinese government daily publications from June 2006 to July 2012, we find that CSI episodes alienating residual claimants’ stakeholders lead to greater shareholder value destruction. The results suggest that CSI episodes alienating high legitimacy claims of shareholders and customers, high urgency claims of employees and powerful claims of customers result in a more pronounced underperformance. Although there are potentially overlapping boundaries between fixed and residual claimants under special circumstances, the findings provide implications for firms making strategic decisions involving multiple stakeholders.

Abstract 307: Real-world Clinical Characteristics and Recurrence Burden of Patients Diagnosed With Recurrent Pericarditis in The United States

Introduction: Real-world data describing acute pericarditis (AP) etiology in the US are limited. Data on the characteristics of recurrent pericarditis (RP) patients (pts) are also sparse. To fill this gap, our study assesses longitudinal data from a nationwide privately-insured population. Methods: OptumHealth Reporting and Insights employer claims data (1/2007-3/2017) were used. AP pts were identified and categorized as idiopathic or non-idiopathic etiology based on presence or absence of attributable conditions. Among idiopathic AP pts, a subgroup of RP pts was identified. Recurrence was defined as ≥2 AP events separated by >4 weeks. First recurrence date marked the index date. Pts aged ≥18 years with ≥12 months of continuous enrollment pre-index (baseline) were included. Results: Of 17,168 AP pts, 4,175 (24.3%) had non-idiopathic and 12,993 (75.7%) had idiopathic etiology (Table 1). Application of inclusion criteria left 8,822 idiopathic AP pts, of whom 1,604 (18.2%) had ≥1 recurrence during a mean observation period of 29 months. On average, idiopathic RP pts were aged 50.7 years, 51.6% female, and 42.3% had baseline history of hypertension, 23.8% of coronary artery disease, 11.7% of hypercholesterolemia, and 7.3% of myocardial infarction. Mean (±SD) time from initial AP diagnosis to first recurrence was 8.7 (±12.1) months and mean (±SD) number of recurrences was 1.7 (±1.3) per pt. In idiopathic RP pts with ≥4 years of follow-up after the initial AP diagnosis (N=512), 35.9% had ≥2, 18.2% had ≥3, and 9.8% had ≥4 recurrences within 4 years. Conclusions: The etiologic distribution and proportion of pts with RP are consistent with previous reports. About 36% of RP pts experience ≥2 recurrences after AP diagnosis over 4 years. RP represents a significant clinical burden for affected pts.

Direct, Absenteeism, and Disability Cost Burden of Obesity Among Privately Insured Employees: A Comparison of Healthcare Industry Versus Other Major Industries in the United States.

To compare obesity-related costs of employees of the healthcare industry versus other major US industries. Employees with obesity versus without were identified using the Optum Health Reporting and Insights employer claims database (January, 2010 to March, 2017). Employees working in healthcare with obesity were compared with employees of other industries with obesity for absenteeism/disability and direct cost differences. Multivariate models estimated the association between industries and high costs compared with the healthcare industry. Obesity-related absenteeism/disability and direct costs were higher in several US industries compared with the healthcare industry (adjusted cost differences of $-1220 to $5630). Employees of the government/education/religious services industry (GERS) with obesity (BMI of 30 or greater) had significantly higher odds of direct costs at the 80th percentile and above (odds ratio vs healthcare industry = 2.20; P < 0.05). Relative to the healthcare industry, employees of other industries, especially GERS, incurred higher obesity-related costs.

Dehumanization 'Because of Sex': A Neutral Approach to the Rights of Sexual Minorities Under Multiaxial Analysis

Although Title VII prohibits discrimination against any employee “because of such individual’s . . . sex,” legal commentators have not yet accurately appraised Title VII’s trait and causation requirements embodied in that phrase. Since 2015, most courts assessing the sex discrimination claims of LGBT employees began to intentionally analyze “sex” as a trait using social-construction evidence, and evaluated separately whether the discriminatory motive caused the workplace harm. Responding to what this Article terms a “doctrinal correction” to causation within this groundswell of decisions, the Supreme Court recently issued an “expansive” and “sweeping” reformulation of but-for causation in Bostock v. Clayton County, one that combined the sex-trait analysis with causation analysis in determining that “traits or actions” related to sexual orientation or gender identity are protected. Because Bostock did not foreclose the use of social evidence or intersectional approaches in additional subordination contexts in which sex is a factor, this Article builds on this important development by introducing “multiaxial analysis,” a framework with which judges and stakeholders identify the role of Title VII’s protected traits as socially constructed along four axes: the aggrieved individual’s self-identification, the defendant-employer, society, and the state. This context-sensitive approach to subordination has the potential to give fuller effect to Title VII’s provisions and purposes as compared to sex-stereotyping theory or the Court’s reformulated “but-for causation.” Uncoupling causation from the sex trait analysis realizes the statute’s civil rights protections within relational, structural, and institutional dynamics as the law increasingly recognizes that the scope of sex extends beyond a fixed binary.

Universalization of Minimum Wages As A Pipe Dream: Many Discontents of the Code on Wages, 2019

The Code on Wages, 2019 (‘Code’) seeks to universalize the law on minimum wages in India by removing the distinction between scheduled and non-scheduled employment that has been central to the application of the Minimum Wages Act, 1948. The Union Ministry of Labour and Employment claims that the elimination of this dichotomy will extend the protection of minimum wages law to more than an estimated fifty crore workers. This paper posits that the goal of universalization of minimum wages may remain a pipe dream due to several explicit exclusions, definitional limitations, and ambiguities in the Code. As a result, not only would many wage workers still remain outside the ambit of minimum wages protection, the coverage of domestic workers, who were earlier covered under the Minimum Wages Act, 1948, may also be imperilled. Further, the exclusion of employment guarantee programmes from the ambit of the provisions on minimum wages also contravenes the constitutional prohibition against forced labour under Article 23. In addition, the Code also fails to address some of the critical structural barriers in the labour economy that have impeded the implementation of minimum wages law so far. This paper argues that the Code’s failure to recognize an entitlement to minimum wages for every wage worker and address the systemic hurdles in the payment of minimum wages undermines the goal of universalization of minimum wages as well as the constitutional mandate on payment of minimum wages

'Sorry, It’s My Bad, but You’re Still Fired--&amp;amp; Have No Case': The Honest Belief Defense in Employment Law

'Sorry, It’s My Bad, but You’re Still Fired--&amp;amp; Have No Case': The Honest Belief Defense in Employment Law

APA Joins Other Medical Groups to Call for Balance in ‘Surprise’ Medical-Billing Legislation

APA Joins Other Medical Groups to Call for Balance in ‘Surprise’ Medical-Billing Legislation

Creating Intangible Capital

We propose a new framework modelling intangible capital creation as the joint investment of firm resources and skilled human capital. High-intangible firms require less ex-ante cash spending yet must offer more deferred compensation to retain employees, creating unhedgeable risk. A human capital retention motive for financial prudence thus arises, even absent traditional precautionary needs. Insuring unvested claims requires more net cash in good states and equity rather than debt financing. Because intangibles can be easily diverted, firms need more inside equity and unvested employee claims can exacerbate turnover. The model offers an explanation for recent puzzling trends in corporate financing.

Direct and Indirect Cost of Obesity Among the Privately Insured in the United States: A Focus on the Impact by Type of Industry.

To evaluate obesity-related costs and body mass index (BMI) as a cost predictor among privately insured employees by industry. Individuals with/without obesity were identified using the Optum Health Reporting and Insights employer claims database (January, 2010 to March, 2017). Direct/indirect costs were reported per-patient-per-year (PPPY). Multivariate models were used to estimate the association between obesity and high costs (more than or equal to 80th percentile) by industry. Overall (N = 86,221), direct and absenteeism/disability cost differences between class I obesity (BMI 30.0 to 34.9) and reference were $1,775 and $617 PPPY, respectively (P < 0.05). Among employees with obesity (BMI more than or equal to 30), highest total costs were observed in the government/education/religious services, food/entertainment services, and technology industries. Class I obesity increased the odds of high costs (more than or equal to 80th percentile) within each industry (odds ratios vs reference = 1.09-5.17). Obesity (BMI more than or equal to 30) was associated with high costs among employees of major US industries.

Pojęcie niewypłacalności pracodawcy w ustawie o ochronie roszczeń pracowniczych w razie niewypłacalności pracodawcy

This article analyses selected scenarios linked to the concept of employer’s insolvency by the Act of 13 July 2006 on the protection of employee claims in the event of employer’s insolvency. The author takes on the subject title by referring primarily to the protective function and pointing to difficulties in interpreting the provisions of the said Act associated with the concept of insolvency. The analysis leads to a conclusion that according to the Act the employer’s insolvency does not necessarily mean that the employer has no funds to pay the amounts due to employees. The reports of the Chief Labour Inspector on the operations of the National Labour Inspectorate lead one to a conclusion that the protection provided under the Act is not sufficient. The author advocates adopting new solutions under the Act, with a view to future law.

Medical Malpractice in Image-Guided Procedures: An Analysis of 184 Cases

PurposeTo report types and outcomes of a small subset of malpractice lawsuits filed against physicians performing image-guided interventions in the United States. Materials and MethodsIn total, 1,312 cases involving common image-guided procedures were reviewed from the Westlaw and LexisNexis databases in the United States from 1963 to 2018. Social Security, disability, employment contract, product liability, criminal, and government employment claims were excluded. The final legal cohort comprised 184 (14.0%) cases. They were categorized into vascular (113/184; 61.4%), inferior vena cava filter (n = 22; 12.0%), neurointerventional (n = 13; 7.1%), gastrointestinal and genitourinary (n = 17; 9.2%), foreign body (n = 7; 3.8%), biopsy related (n = 9; 4.9%), and oncologic (n = 3; 1.6%) interventions. Claims were also organized by defendant type and by specialty, complication stage, verdict, and year. ResultsFrom 2001 to 2018, 58.7% of claims (n = 108) were reported. Procedural complications related to arteriography were most commonly litigated (63/113; 55.8%). Claims arising from intra-procedural and early post-procedural complications were common (84/184; 45.7%). Community hospitals were most often named as defendants (61/184; 33.2%). In reported outcomes, courts sided with defendants in 81.9% (104/127) of the cases, similar to national malpractice trends. Unreported outcomes comprised 31% (57/184) of the data. ConclusionsFor the small subset of claims published within national legal databases, intra-procedural and early post-procedural complications after diagnostic arteriography were most commonly litigated. Most (81.9%) claims with reported outcomes sided with the defendant physician.

Evaluating the impact of workers' compensation policy in Australia using insurance claims data and comparative quasi-experimental methods

Australia, like the USA, has state-based workers’ compensation (WC) systems that provide income support, healthcare and rehabilitation for injured and ill workers. The eleven major Australian WC systems provide coverage for over 90% of the labor force and accept approximately one quarter of a million new claims per annum. Governments commonly use changes in scheme design (most often enacted through legislative amendment) to influence WC system performance including rates of claiming, costs and return to work (RTW) outcomes. Using a national, longitudinal, case level dataset of WC insurance claims data, we evaluated the impact of multiple, state level legislative amendments. The impact of legislative amendments in the states of South Australia (year of 2009), Tasmania (2010), Victoria (2010) and New South Wales (2012) were evaluated using interrupted time series analysis. Outcomes included volume and incidence of accepted WC claims, employer and insurer claim processing timeframes, and duration of work disability. Major findings include (1) the Tasmanian amendments designed to improve RTW outcomes failed; (2) the South Australian amendments designed to encourage early employer claim lodgment were partially effective; (3) the New South Wales amendments designed to ensure the financial viability of the WC scheme reduced access to benefits and disproportionately affected workers with occupational disease and mental health conditions; (4) the Victorian amendments designed to increase benefit generosity led to an increase in claims and longer duration of disability. Study findings demonstrate both intended and unintended consequences of WC system reform, and provide an evidence base for future reform.

MP44-11 CREATION AND VALIDATION OF A CLAIMS-BASED ALGORITHM FOR IDENTIFYING IN-VITRO FERTILIZATION SERVICES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life & Shared Decision Making I1 Apr 2018MP44-11 CREATION AND VALIDATION OF A CLAIMS-BASED ALGORITHM FOR IDENTIFYING IN-VITRO FERTILIZATION SERVICES James Dupree, Zachary Levinson, Angela Kelley, Jessica Dozier, Marsha Manning, Michael Lanham, Vanessa Dalton, Helen Levy, and Richard Hirth James DupreeJames Dupree More articles by this author , Zachary LevinsonZachary Levinson More articles by this author , Angela KelleyAngela Kelley More articles by this author , Jessica DozierJessica Dozier More articles by this author , Marsha ManningMarsha Manning More articles by this author , Michael LanhamMichael Lanham More articles by this author , Vanessa DaltonVanessa Dalton More articles by this author , Helen LevyHelen Levy More articles by this author , and Richard HirthRichard Hirth More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1430AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Infertility is a disease, and understanding practice patterns for in-vitro fertilization (IVF) is important for improving access to fertility treatments. However, studying IVF in claims data is challenging because it is a rarely covered benefit, although other services provided in conjunction with IVF are often covered. Therefore, we sought to create and validate an algorithm for identifying IVF in administrative claims data. METHODS We utilized claims data from a large university employer that began offering IVF as a covered benefit in January 2015. We used employee claims data from September 2014 to January 2017 for women 22-46 years old to evaluate multiple algorithms that combined covered services or medications to predict IVF cycles. We defined our gold standard as Current Procedural Terminology (CPT) code 58970 (follicular puncture for oocyte retrieval). We then generated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy characteristics for each algorithm. Finally, we performed a primary chart review to validate the final algorithm. RESULTS The best performing claims-based algorithm used a combination of two or more pelvic ultrasounds (CPT 76830, 76856, or 76857) within two days of each other plus a prescription for either menotropin or ganirelix within 58 or 88 days of the most recent ultrasound, respectively. In addition, the algorithm excluded episodes of fertility preservation and intrauterine insemination. The final algorithm had high sensitivity, specificity, NPV, and accuracy for predicting IVF (Table). The PPV was moderately high, reflecting the rate of false positives and relatively low volume of IVF. Of the 51 false positives, primary chart review identified 22 (43%) as canceled IVF cycles and 18 (35%) as IVF cycles likely occurring outside the healthcare network covered by the insurance policy. CONCLUSIONS A claims-based algorithm using paired pelvic ultrasounds and hormonal medications commonly used for IVF has high sensitivity, specificity, NPV, and accuracy for predicting IVF cycles. This algorithm will be useful for researchers, policymakers, and clinicians who aim to better understand large scale IVF practice patterns using administrative claims data. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e591-e592 Advertisement Copyright & Permissions© 2018MetricsAuthor Information James Dupree More articles by this author Zachary Levinson More articles by this author Angela Kelley More articles by this author Jessica Dozier More articles by this author Marsha Manning More articles by this author Michael Lanham More articles by this author Vanessa Dalton More articles by this author Helen Levy More articles by this author Richard Hirth More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Employee claims documentation request was burdensome

Case name: Harrison v. SUNY Downstate Medical Center, et al., No. 16‐CV‐1101 (E.D. N.Y. 09/25/17).

Disease Severity and Baseline Characteristics of Patients Receiving Mepolizumab or Omalizumab in Employer Claims Database: A real-world experience

Disease Severity and Baseline Characteristics of Patients Receiving Mepolizumab or Omalizumab in Employer Claims Database: A real-world experience

A Case of Putting the Cart Before the Horse?

In the case of Beatt v. Croydon Health Services Trust,1 the Court of Appeal has recently handed down a judgment that, if it stands, will have profound implications as to the proper approach to be adopted by tribunals in whistle-blowing cases where the conduct relied on by the employer as the reason for the dismissal is inextricably connected to what the employee claims to have been the making of the ‘protected disclosure’ in question: for example, where an employee is dismissed for making allegations concerning safety issues which the employer believes were not only unfounded but were made knowing that they were unfounded, and for an ulterior purpose. (Although the appeal raised a number of subsidiary issues, the focus of this note will be on the main issue and the facts relevant to it.) The legal background against which much of the argument in the Court of Appeal was centred can be summarised in a few sentences, and involves the interplay between sections 98 (1) and 103A of the Employment Relations Act 1996. Section 98 (1) requires the employer to show that the reason or principal reason for the dismissal of the employee relates to capability, conduct or redundancy or ‘some other substantial reason which would justify dismissal’. Only if the employer can show such an admissible reason, can the tribunal proceed to consider whether the decision to dismiss was a reasonable one in all the circumstances. Section 103A provides that an employee ‘shall be regarded as having been unfairly dismissed if the reason or…principal reason for the dismissal is that the employee made a protected disclosure’. A ‘protected disclosure’—a concept introduced by the Public Interest Disclosure Act, 1998—means the disclosure of information relating to a number of specified matters, in particular for present purposes, health and safety concerns, and which is made in the reasonable belief that the information is true. It has been settled law that what is to be treated as ‘the reason or principal reason for the dismissal’ in the context of section 98 (1) is, in the familiar words of Cairns LJ in Abernethy v. Mott Hay & Anderson, ‘a set of facts known to the employer, or it may be of beliefs held by him, which cause him to dismiss the employee.’: emphasis supplied.2 Thus, a genuine belief in an employee’s dishonesty can be an admissible reason even if that belief is subsequently found by a tribunal to have been mistaken. Where it is alleged that the reason for dismissal was the making of a protected disclosure, the position has generally been understood to be as stated in Kuzel v Roche Products Ltd: namely, although the claimant needs to provide some evidence to support his case that the reason for his dismissal was the making of a protected disclosure, the overall burden remains on the employer to show that the reason for the dismissal was a potentially fair one; ‘if the employer does not show to the satisfaction of the tribunal that the reason was what he asserted it was, it is open to the tribunal to find that the reason was what the employee asserted it was:[i.e. the making of a protected disclosure]’.3

Healthcare resource utilization and costs by age and joint location among osteoarthritis patients in a privately insured population

Aims: To compare healthcare resource utilization and costs between patients aged 18–64 years with osteoarthritis (OA) and matched controls without OA in a privately insured population.Methods: Patients with OA were selected from de-identified US-based employer claims (Q1:1999–Q3:2011). The index date was defined as the first OA diagnosis indicated by ICD-9-CM codes. One year before and after the index date were defined as the baseline and study periods, respectively. A second OA diagnosis during the study period was also required. Patients with OA were matched one-to-one on age, gender, index date, and minimum length of follow-up to controls without OA. Baseline characteristics and study period resource utilization and costs (2016 USD) were compared between cohorts.Results: This study identified 199,539 patients with OA (knee: 87,271, hip: 19,953, hand: 15,670, spine: 12,496). The average age was 54 years, and 58% were female. OA patients had higher healthcare resource utilization than matched controls in inpatient, emergency room, and outpatient settings (p < .001 for all). Further, patients with OA had 4-times the excess total medical costs of their matched controls ($14,521 vs $3,629; p < .001). Patients with hip OA had the highest medical costs among all joint locations. Outpatient and pharmacy costs were similar among patients with knee, hip, and hand OA, but higher in patients with spine OA. In sub-group analyses, older patients (45–64 years old) had higher costs.Limitations: This sample, obtained using claims data, only includes patients who were actively seeking care for OA and were likely symptomatic. Asymptomatic patients would likely not be captured in this analysis.Conclusions: Patients with OA incur greater healthcare resource utilization and costs than patients without OA, with substantial variation by joint location.

Decisions of British Courts during 2015 Involving Questions of Public or Private International Law

... Whether employing a domestic worker constitutes a ‘commercial activity’ for the purposes of excluding immunity under article 31(1)(c) of the Vienna Convention on Diplomatic Relations; whether a diplomat has immunity from service of proceedings In Al-Malki v Reyes, the Court of Appeal held that (1) employment of a domestic worker did not constitute a ‘commercial activity’ for the purposes of excluding immunity under article 31(1)(c) of the Vienna Convention on Diplomatic Relations 1961 (VCDR), even if the employee had been trafficked; and (2) the inviolability of the diplomat and her/his premises prohibited service in person but not by post. The appellants, former domestic workers, appealed against a decision of the Employment Tribunal (Langstaff J) that the respondent Saudi Arabian diplomats could claim immunity in relation to employment claims brought against them.1 The appellants had brought claims against the respondents for racial discrimination and harassment, and failure to pay the national minimum wage. In response, the respondents claimed immunity pursuant to articles 31 and 37 of the VCDR, which is incorporated into English law by section 2 of the Diplomatic Privileges Act 1964 (DPA). The appeal concerned three issues: (1) whether a contract of employment between a serving diplomat and a domestic worker was to be characterised as ‘commercial activity exercised by a diplomatic agent in the receiving State outside his official functions’ such that the exception to diplomatic immunity contained in article 31(1)(c) of the VCDR is applicable;2 (2) if not, whether the grant of immunity breached article 6 ECHR (right of access to a court) or, on the basis that Ms Reyes had been trafficked into the UK, article 4 ECHR (prohibition of slavery and forced labour); and (3) whether diplomats had immunity from formal service of proceedings. The Court’s judgment was given by Lord Dyson MR, with whom Lady Justice Arden and Lord Justice Lloyd Jones agreed.

Fired for threatening behavior, employee claims discrimination

Case name: Bolanos v. Northeastern Illinois University, et al., No. 14 CV 7533 (N.D. Ill. 01/04/17).

Discrimination complaints led to termination, employee claims

Case name: Nebel v. Oakton Community College, et al., No. 16 cv 4613 (N.D. Ill. 11/07/16).