Building a Better Workplace

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Text, Travelers. Be Risk Ready: What's Trending in Total Worker Health (registered trademark). Bill Malugen. Executive Vice President and President, National Accounts, Travelers. Bill stands on an event stage. Audience members sit at round tables.

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BILL MALUGEN: Thanks for being with us. I'm sure there's lots of folks here who have been coming to RIMS for decades. I was actually thinking about, yesterday morning when I was getting dressed, how many RIMS I've been to, and I came up with it's 26 or 27. But some of these get a little blurry back in the day.

A little better now. Don't stay out quite as late, but we've all been coming for a long time. But from a risk management perspective, talking about the cost of risk and total cost of the risk is not that different today than maybe it was 25 years ago. But I think the expectations on risk managers and the risk management function today are quite different than what we would have seen a couple of decades ago.

I mean, certainly think about the litigious environment that we're in. I mean, I think virtually every customer meeting I had the last couple days we talked about some element of social inflation, certainly catastrophe management. There are a lot of conversations on the change and the change of the property market and property environment. Also coming out of COVID, understanding the changing dynamics of the workplace and worker mental health, and then laid on top of that, really, a new, I think, heightened environment in terms of safety concerns and safety consciousness on both the part of the employers and the workers.

So certainly, a lot of education opportunities to support both the risk management function as well as our front-line employees. And that's really our goal today is to help further that discussion from a worker health and worker safety perspective. And so I'm thrilled to be able to have my colleague Joan Woodward here with us today. Joan will be up in a second, and just to give a little introduction for her, she is the-- she's a recognized leader in the insurance and financial services industries. And she serves as President of our Travelers Institute as well as Executive Vice President of Public Policy for the Travelers.

So, she speaks frequently. You may have seen she does a Wednesdays with Woodward podcast, videocast.

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Joan smiles and laughs from her seat in the audience.

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I don't know whether you call it a podcast or a videocast. It's a podcast with pictures. We'll do that.

So she does that every week. Lots of great-- lots of great content. I'm sure she'd love to have you, but it's varied topics, but always really interesting. Encourage you to check that out.

She joined Travelers in 2008 to establish our Travelers Institute, which was at the time pretty cutting-edge we thought. I don't think anybody else had that, but it really did establish thought leadership and public policy platform for the company and to really talk about issues in front of the insurance industry. And that has been super successful and engaged a lot of different constituencies over the years.

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The screen behind Bill displays a picture of Joan and reads, Joan Woodward, Executive Vice President, Public Policy, Travelers Institute.

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She's got extensive Capitol Hill experience as well as Wall Street experience. She joined us from Goldman Sachs. So she's got a broad perspective on a lot of topics, particularly from a Washington perspective for us. So she'll lead us through the conversation.

First I'd like to introduce, though, before we get started, with the lay of the topic out for us is, I'm thrilled to introduce Dr. L Casey Chosewood from the Centers for Disease Control and Prevention right here in Atlanta. Dr. Chosewood serves as the Director of the Office for Total Worker Health within the National Institute for Occupational Safety and Health.

So we're thrilled to have him with us.

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Dr. Chosewood looks up from the audience.

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In his role at NIOSH, he promotes the safety, health and well-being of workers through research, intervention, development and partnerships. Previously, he served as Director of CDC's Office of Health and Safety, which served the CDC's 15,000-person workforce and as Medical Director of CDC's three occupational health clinics, among other leadership roles.

He's also got background as a family physician, serving-- doing that for 10 years previously. And so he's got a lot of insights in terms of worker health that he's going to share with us today. And so we're thrilled to have him, so Dr. Chosewood, come on up. Thanks.

L. CASEY CHOSEWOOD: Good morning.

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Dr. Chosewood comes on stage. Text, L. Casey Chosewood, M.D., M P H. Director, National Institute for Occupational Safety and Health's Office for Total Worker Health (registered trademark). The screen behind him reads, Travelers Breakfast: Risk World Atlanta 2023. May 3, 2023.

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Well, welcome to Atlanta, my hometown, and also home to the Centers for Disease Control and Prevention, as Bill mentioned. Thanks to Joan and Bill for inviting me today. It's been great to get to know them and to work with them over the last few months.

To learn, really, more about what you guys do and about the challenges that you're facing, and I think we have an opportunity today to talk about some of those issues in the context of public health-- the kind of bread and butter of CDC-- as well as the day-to-day operations of NIOSH. So CDC is headquartered here in Atlanta. We're one of the few, or perhaps maybe the only federal agency that's not headquartered in the Virginia, D.C., Maryland area.

And in all honesty, we like that, OK [LAUGHTER]? Sometimes it gets a little thick and heavy up there. We make every attempt to be apolitical in our work. And as you guys know, the past few years have challenged that quite a bit. So I will give everyone one opportunity to say one curse word directed at CDC, OK? [LAUGHTER] If you throw a shoe, make sure it's a size 13, OK? [LAUGHTER].

It is my pleasure to be with you. As I mentioned, NIOSH is one of many components at CDC. In fact, it's the Centers for Disease Control because we have about 10 national centers there. NIH has maybe about 40 institutes up at NIH, so we have a number of components, as well.

NIOSH, however, is not headquartered here in Atlanta. We were created and became part of CDC at the same time that OSHA was created. So we're co-located in Washington, D.C., near the Department of Labor, but we're actually the scientific, the laboratory arm that does much of the research that underpins all of the OSHA regulations that companies follow.

It's a nice relationship to be separate but yet supportive of them. We can also stay out of the regulatory space, which we really much enjoy. It also keeps us less political in our day-to-day operations, which we find beneficial, as well. We're going to talk about some of the trends that are impacting not only occupational safety and health, but you as folks who interact with working people. Work, perhaps more than any other aspect of life, was impacted by the pandemic even more so than the way we deliver health care, the way we delivered goods and services. All those things important. They change rapidly, but those were narrow, if you will, subsets of workers.

Work in every experience, in every sector, in every cross sector of our economy, every industry and occupation changed dramatically because of COVID. How we're moving on beyond that, how we're bouncing back is an important discussion for us today. It impacts risk. It impacts the way we interact with our own lives, and how we make a living and how we move forward for our families and ourselves. And more importantly, people are thinking more about what they want out of work and what they want out of a job. So let's take a deeper dive into some of those issues today.

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The slide behind Dr. Chosewood reads, "Survival Mode." Americans report elevated levels of stress, worry and uncertainty. Lingering pandemic. Reports of high stress levels. Inflation, supply chain and "life logistics." Political divides and global unrest. Caregiving, child and family issues are a major source of worry for many. Quiet quitting, great resignation, return-to-work woes. "One of every three employees say their return to the workplace has had a negative impact on their mental health, and they're feeling anxious and depressed."

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A lot of Americans are reporting to CDC in a variety of national surveys that they're just barely hanging on. In fact, it's been called, we're all in a survival mode. Some people have lingering aspects of the pandemic not from a significant infection standpoint because that's pretty much behind us, we believe. We don't expect any significant surges, increases in hospitalizations, increases in death rates. Those are not anticipated.

We have almost universal coverage in this country with immunity to COVID-19, largely because of good vaccination rollout, and also lots of people with naturally acquired infection. Both of those, we believe, really give folks really good immunity from future outbreaks. The pandemic actually officially ends on May 11, so that's just days away when the national emergency of the COVID-19 pandemic is declared over by CDC and the Biden administration.

Also bringing changes with it, as well-- decreased funding in some sectors of the population, decreased restrictions on travel. People can enter the country without vaccination now. There's no federal requirement for vaccination to be employed, as was the case earlier. So, many changes occurring after May 11.

But in addition to the pandemic, what we've seen is other social upheavals that have not recovered as quickly as perhaps some of the infection rates have. The child care situation, the caregiving issues, continue to linger. The supply chain, the just life logistics that people struggle with, continue to day to day be a challenge for some people.

And one out of every three workers say their return to work has worsened their state of mental health, their well-being. We do not leave those challenges at home. Those come with us to work every day. And how we manage those and how they play themselves out when it comes to workplace injury, to relationships with coworkers, with our productivity, all a very important issue.

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The next slide reads, Unsettling, unprecedented trends. Life expectancy losses. Increases in overdose deaths and suicides in some groups. Educational losses. Chronic disease screenings, diagnoses, and management delays. New orphans and ACEs. Worldwide: 10.5 million children lost one or both parents, including 4.2 million in Southeast Asia, 2.5 million in Africa, 1.5 million in the Americas, 1.5 million in the Eastern Mediterranean region and 500,000 in Europe. United States: about 250,000 children lost one or both parents.

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CDC is also very much interested in some trends, some sort of lifestyle and lifelong trends that we're going to be watching very, very closely. If you're a woman in the room, your gender lost about one to two years of life expectancy because of the COVID-19 pandemic. 1.1 million people died in this country. If you're a man, that number is about double. So about two years of life expectancy loss from the pandemic alone. We've not had such an abrupt event since the 1919 flu caused similar drops in life expectancy.

Some populations far worse. America Indian, Alaska Native, five to six years of life expectancy loss because they were especially hard hit. High numbers of people died in that population. Now, you might think one to two years, not all that dramatic. It is in perspective when we state it this way.

It took the last 40 years to gain those one to two years of life expectancy. With all our medical research, all our treatments for cancer, and better survival for heart disease and other chronic conditions, 40 years to gain two years of life expectancy lost very, very quickly. So an important takeaway that these dramatic events will forever change the nature of our country.

We still don't know the full story on all these delays-- how significant they will be, what will be some of the challenges that we see from the perhaps adverse childhood events like losing a parent. Two hundred fifty thousand new orphans in the United States, educational losses-- these are unknown, untold costs to the pandemic. Those will play out over the next generation or two.

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The next slide reads, Current Priorities of the U.S. Surgeon General. Our Nation's Current Workplace Landscape. Recent surveys suggest... 76% of U.S. workers reported at least one symptom of a mental health condition. 84% of respondents said their workplace conditions had contributed to at least one mental health challenge. 81% of workers reported that they will be looking for workplaces that support mental health in the future.

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The surgeon general has worked hard in this area. The surgeon general is part of our parent Department of Health and Human Services at CDC, and they report some pretty startling numbers from their surveys. Three quarters of U.S. workers reported at least one symptom of a mental health condition-- traumatic. Especially when you think about pre-pandemic, those numbers were closer to 25%. It's a dramatic increase. More than 8 in 10 said their workplace conditions had contributed to at least one mental health challenge, and the same number reported that they will be looking for workplaces that support their mental health in the future.

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The first two figures are attributed to the Mind Share Partners' 2021 Mental Health at Work Report. The last is attributed to the APA's 2022 Work and Well-being Survey Results.

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We also see these numbers play out differently across populations, and we'll get into some of those details, as well.

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The next slide reads, Workplaces Play a "Foundational Role" in Our Mental Health. At least one workplace condition has had a negative effect on the mental health of more than 80% of workers in the US. In 2021, about 1 in every 37 working adults experienced serious psychological distress severe enough to impair social/work function and to require treatment. People working the night shift were twice as likely to report serious psychological distress than people working the day shift; rotating shifts and insecure income also elevated risks. Psychological distress is significantly higher among workers who did not have sick leave. About 1 in 17 people who had to work when they were physically ill reported serious psychological distress - three times more than those who didn't have to work when sick.

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One in 37 working adults experience serious psychological distress severe enough to impair social and work function and to require treatment. That's roughly 3%. And about twice that number who had to work when they were physically ill reported serious psychological distress. That's three times more than those who did not have to work when sick.

So again, it shows the importance of certain protections like paid sick leave, like certain benefits are going to continue to be important to maintain high levels of productivity to decrease the costs associated with some of these chronic conditions.

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The next slide shows an infographic of 10 human figures, with nine colored red. Text, 9 out of 10 health workers experienced stress in June to September 2020.

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I'm going to pay a few minutes’ attention just to the situation in health care, and I do that for two reasons. First, very big sector. More than 20 million workers in the health sector, even more if you count some of the support roles in health workers.

But this is a sector that, because of its importance to day-to-day health and functioning, its impact spills over into every other part of our lives. And I think that's an important takeaway. If we're not getting the care of health workers right, every other type of worker, every other type of family, every other population, especially vulnerable ones, will suffer, as well. Nine out of 10 reported high stress levels during the pandemic. Three quarters reported exhaustion and burnout by September of 2020, roughly six to seven months in.

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The next slide reads, 76% of health workers reported exhaustion and burnout in September 2020. 79% of physicians said their burnout started before the pandemic.

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And almost 80% of physicians said their burnout started before the pandemic. That's a double whammy. People who were already struggling before the pandemic then had the massive onslaught of long hours, fatiguing work, exposure to grief, worried about taking an infection home to their families. This was really a challenging time for these workers.

Seven in 10 reported feeling depressed. Recall we said those numbers pre-pandemic were 25%.

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The next slide says, 69% reported feeling depressed. 13% reported having suicidal thoughts.

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We call this a compression of morbidity. So mental health conditions do play out over the course of our lifetime. Usually, about 1 in 4, 1 in 3 people over their lifespan will report mental health conditions.

We were hearing more people than that compressed into only a period of two years-- compressing that lifetime risk of mental health conditions from a lifetime into a very narrow window of time. And about 1 in 6 reported having suicidal thoughts. That is more than in the general population where that number is roughly during the pandemic about 1 in 11 people. So this was quite concerning.

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The next slide reads, In a summer 2021 survey, nurses reported feeling: 75% stressed, 58% anxious, 67% exhausted, 35% depressed.

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Nurses also did similarly poorly. Nurses oftentimes report this challenge that is termed moral injury, meaning they felt like they were falling short of being able to do their work in the way they wanted to do. They were not-- they didn't have the resources. Maybe they didn't have the energy. Maybe they didn't have the PPE or the supplies they needed to be able actually to deliver the care that needed to be delivered.

And they recognize that, and they carry tremendous guilt from not being able to deliver the services that they knew their patients needed. They oftentimes were seeing people die and be the only sole caregiver holding the hand of that person. Usually it's a family member who's in that situation, but COVID took away all of those supports that were present usually by the bedside.

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The next slide reads, 34% said they were not emotionally healthy. 42% experienced an extremely stressful, disturbing or traumatic event as a result of COVID-19. From summer 2020 to summer 2021: 350% increase in self-reported burnout.

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About 1 in 3 claim they were not emotionally healthy. More than 40% said they experienced an extremely stressful, disturbing or traumatic event. Many of these were the deaths of patients or where they felt the care they were supposed to be able to give was not possible during this condition.

Three hundred and fifty percent increase in burnout. This is mid-pandemic. And if you're following injury rates in health care, and my guess is some of you follow that quite closely, in 2021 there was a 250% increase in OSHA recordable injuries in health care-- 2 1/2 times the average rate of injury in health care. Never has any sector seen such a dramatic rise for any reason.

So this wasn't just mental health issues playing out, this was injury and illness to the level of being recordable on the OSHA log. So important takeaways here. This was a multiple level of significant challenge in this space.

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The following slide says, Over 2 in 5 public health workers are considering leaving their jobs within 5 years. 76% of those workers started to consider leaving during the pandemic. 51% thought more staff capacity was needed.

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Public health workers, like those of us at CDC, also reported high levels of stress, depression, anxiety and public discontent. No surprise there. One study showed that a full 25% of Americans thought it OK to be violent against a public health official because of the circumstances that our country found itself in. Obviously, some shortages, as well, in that public health space.

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The next slide reads, 1 in 5 physicians and 2 in 5 nurses intend to leave their practice. Predictors of intention to leave: Burnout. Fear of exposure to virus. COVID-19-related anxiety/depression. High workload,

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Here you can see what are predictors, if you will, of intention to leave, turnover. And we're quite worried about turnover in health care because they're highly trained, highly skilled, highly specialized. You can't just find a replacement quickly for some of these jobs.

Burnout, top of the list. Fear of exposure to virus, less so now. A big deal during the first six months of the pandemic pre-vaccination. COVID-19-related anxiety and depression and continued high workload.

About half of nurses intend to leave within the next six months. Top reasons very similar to those we just mentioned. Here's an important takeaway. This is from the Board of Nursing. One hundred thousand registered nurses in the U.S. left the workplace. That's a dramatic number.

This represents maybe 6 to 7% of hospital registered nurses. Folks, they run a shortage almost every day in adequate levels of nursing. You take out 6% of that, those numbers dramatically rise.
Under the American Rescue Plan, our institute was given $20 million to develop a mental health campaign for health workers. This data fed into the development of that. Within the next month or so, we'll launch a multimedia social marketing campaign to improve the mental health of health workers, and what did folks tell us?

They already know there's an issue. They don't need to know that things are bad. They feel it every single day. They also told us that they don't want a lunch-and-learn on how to eat healthier.

You can't overcome 10, 12 hours of terrible working conditions with a lunch-and-learn on preventing diabetes. It's not possible. They want real change. They want to be heard. They want ability to influence policy. They want better supports. They want better supervision.

So our campaign will be about those things. It will not be about pull off the shelf a wellness program. That's not adequate for the circumstances that all workers are in, right?.

This program will not be about resilience building, either. Resilience is like telling the turtle, please grow a harder shell so I can hit you with a bigger hammer, right? Get rid of the hammer. Decrease the need for me to carry a heavier shell. That is the appropriate way to manage workplace stress and to lower the risk factors for mental health conditions that are costly, oftentimes lifelong.

So resiliency building is not where most investments in organizations should be made, but you will hear that word continuously when it comes to managing high levels of workplace stress. We think that puts all the onus also on the person who's suffering. You're not strong enough. You're not being able to weather all of the stings and arrows that we're throwing your way.

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The slide behind Dr. Chosewood reads, NIOSH Health Worker Mental Health Initiative. A graphic of a wheel reads, CDC/NIOSH action hub in the center. Around the outside, icons correspond to the phrases, generate awareness, identify and adapt tools, partner, assimilate evidence, and understand HW burden.

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Get rid of the stings and arrows. That's the important takeaway.

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The following slide reads, Future-casting the Way We Will Work. Uncertainty rules: rapid pace of change, relentless innovation. General and specific labor shortages likely to remain. Work arrangements continue to shift (remote work, temp work, multiple jobs, new benefit innovations). Upheavals in certain industries, led by the energy transition/technology. Mining, oil/gas extraction, manufacturing, transportation. Technology rewires every aspect of work for almost all workers. Stark mismatch of tech and human evolution. Old hazards will remain and increase in some settings.

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Let's broaden our conversation in the last few minutes that we have left to talk about where we expect the future of work to go, especially as it relates to our well-being as workers and individuals and how that might influence your work. We believe that the continued pace of change will not slow post-pandemic. Change certainly speeded up, but the way that work is organized, the way it's carried out will continue to quickly change.

Partly because of technology's never-ending, ceaseless-- the ability to do more with fewer people, but yet, the people you have being quite vulnerable to those influences and changes. You see, technology evolves much faster than we do as individuals. And the ability to keep up is going to be a constant stressor. People report technology stress every single day as a significant challenge to their ability to work in a healthy manner.

We'll see some upheavals in certain industries. Mining and energy come to mind. Technology will rewrite almost every aspect of the way we work and the stark mismatch that we just talked about. However, many of the old hazards that you deal with each and every day are not going to go away dramatically, either.

We will see some additional outsourcing of risk to contracts and to temporary workers. That continues to be a major issue at our institute where we're quite concerned about the risk to young workers, the risk to temporary workers and contract workers. That is a super concentrated area of risk. My guess is you guys see that every day.

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The next slide says, Future-casting the Way We Will Work (continued). Growth in frequency, duration and severity of mental health (MH) conditions likely across many demographics. Improving awareness of and de-stigmatization around MH issues. Growing pressure for national standards related to psychosocial hazards. Benefits and workplace services become differentiators (employer of choice). Psychosocial workplace risk factors become "front and center." "Worker well-being" established as vital, most influential metric. Focus on solutions and interventions that benefit workers, organizations and society.

(SPEECH)
We also expect growing frequency in the severity and duration of mental health conditions among Americans. Partly it's because we can talk about it more post-pandemic than we could before. So there will be increased recognition.

People will hear someone talking about it and say, hey, I feel that way, too. There will also be less stigma about seeking mental health care. Both of those are going to drive increase in diagnosis, medication usage, and likely, absence and disability from work.

There is an age component to this, as well. Younger workers have two to three times the rate of mental health distress, complaint, symptoms than those over age 65. Right now, those age 18 to 50, 50% in this country today, this is 2023 data, report mental health symptoms. Fifty percent in that 10-year demographic.

We also expect benefits around this space to grow exponentially and become differentiators. People who are wanting to attract workers and retain them will increase their benefits in this space. And we like to focus on this metric because it's hard to measure these things in a positive way. We can measure a lot of negatives, right? We can measure how many people have diagnosis of depression or are on antidepressants, but can we find better positive measures and use those measures to predict better outcomes, and to intervene for people who are struggling?

So we're going to focus on worker well-being as an important metric to follow and to gauge the success of an organization.

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The next slide reads, Future-casting the Way We Will Work (continued). Compensation will shift generally toward more coverage for psychosocial risks (one-time events, ongoing exposures, working condition hazards). WC specialists will need greater expertise in mental health (MH) and its relationships to injury and recovery. Need to gain new insights into mental health conditions vs. other compensable conditions. Earlier onset. Lengthier, more costly periods of compensation, greater variability. RTW, recovery, relapse. Require new case management strategies will be necessary. Will we see compensation related to substance use disorders?

(SPEECH)
We also think compensation will shift generally toward more coverage for psychological risks, whether those are one-time events or ongoing exposures. We're already seeing more of that at some of the state levels-- more and more compensation. Obviously, specialists in this space are going to need greater expertise in understanding mental health, especially these sort of insights.

Unlike most chronic conditions, mental health conditions appear 20 to 30 years earlier. So they become an earlier overlay, an additional cost consideration for any subsequent injury. We know that someone who has a chronic condition, say diabetes, and then gets, let's say, a foot injury, their risks are way, way higher than someone who may have gotten that injury at an earlier age without diabetes. Mental health is a strong modifier-- a very expensive modifier on any injury or illness.

It happens earlier. It's diagnosed earlier. It can be lifelong. It uses more medication over the course of a lifespan than many other chronic conditions, and it's known for relapses, recovery and relapses. So, it is an expensive, worrisome component as we see the next decade or so evolve.

And what about substance use disorders?

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The next slide is entitled, Total Worker Health (registered trademark) Approach. A graphic on the slide depicts a funnel. Overlapping ovals near the top of the funnel read, Keep workers safe, and, establish workplace policies, practices, and programs that grow health. Text beneath the funnel reads, Worker Well-Being.

(SPEECH)
Think we'll talk about it a little bit more in the Q&A, but our research shows that industry and occupation has a very strong influence on one's risk for alcohol-use disorder, cannabis-use disorder, and opioid-use disorder. Such that if you're a construction worker in the U.S. today, your risk of dying of overdose death from drugs is six times that of the average worker.

Folks, this isn't only because people who are prone to overdose death go into construction. This is an indictment on that industry-- the painful working conditions, the long hours, the insecure work, the lack of paid sick leave, in our research, all related to overdose death directly. We also see high rates in some service occupations, and mining, and agriculture, forestry and fishing-- all of those jobs were the sort of boom or bust kind of work, and where we have really tough working conditions-- long hours, unpredictable work. Those are all risk factors for overdose death.

Our antidote is my program, the Total Worker Health approach. It looks at your risks on the job, but also how we can pay attention to the rest of your life, as well. You're not a work person and a home person. You're one person, and you shuttle those challenges and risks back and forth every day. A program to intervene for your well-being should address both home and work challenges.

First, keep workers safe. There is no total worker health without that. A company that doesn't do that is asking you to trade health for wages. Not acceptable. Not legal.

A company that keeps you safe, OK, you go home at the end of the day with the same level of health you arrived with. That's a good thing. The best companies though, the ones that people will clamor to work with to stay on for a lifetime, are those that do more than that. Yes, they keep you safe. But in addition, they invest in programs, policies, practices that actually grow your health.

Wouldn't it be great to have a job that actually gives you the take-home benefit of a better life? Those are the companies that will succeed. Our research shows that companies that do that perform better in the S&P, right? Their stock market performance is better.

We, again, measure this metric of worker well-being, and here are some of those three P's, those add-ins the programs, practices and policies, all on our website. Definitely would love for you to come take a look at our work. Sign up for our regular recurring information free of charge.

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The following slide says, Total Worker Health Policies, Programs, Practices. Worker-centered problem solving. Equitable wages, safe staffing levels. Leave and benefits optimization. More supportive supervision. Discrimination, harassment, and violence prevention. Health-enhancing work design. Fair performance appraisals. Pathways to advancement and development. Attention to work-life fit. Address work factors known to be causes of chronic conditions. Confidential occupational health/prevention services.

(SPEECH)
In addition to detailing how all of these programs, practices and policies work-- some that seem very straightforward, others that might be more challenging to put in place-- we've developed ways to measure worker well-being. Took us five years to validate a solid 68-item, 15-minute questionnaire to better measure worker well-being.

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The next slide is entitled, The NIOSH WellBQ. A new measure of worker well-being. A graphic on the slide depicts a circle that reads, worker well-being, in the center and, home, community, and society at the bottom edge. Four sections around the center of the circle read, workplace physical environment and safety climate, workplace policies and culture, health status, and work evaluation and experience. Text, CDC dot gov slash NIOSH slash TWH slash Well B Q slash default dot HTML.

(SPEECH)
This will allow you to find out what aspect is most challenging to your workers today, and how can we develop programs to intervene for those challenges?

I'm going to close just with a few words on engagement. Why? Because this is what younger workers are telling us matters the most. They want a job with some purpose and meaning, far more than previous generations do. So they're very interested in that my work is making a difference. Almost every job has positive associations with it. We're doing something-- a good, a service, some positive that's going to benefit society.

Telling that story to workers is going to be very important. They want a worker that lets them achieve, that has some moral correctness to it, that gives them autonomy. We asked workers, do you want more vacation time, or you want more day-to-day flexibility? Without fail, they all want more flexibility.

So if I had to sort of sum up, recognize workers, create a positive space, give them meaning for what they're doing as it impacts greater society. Show them the good in the work they do. Use healthier supervision. Give more voice and autonomy to workers. Give them more day-to-day flexibility.

Those are the things that will decrease workplace stress. And by the way, they'll decrease workplace injury, as well.

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The slide behind Dr. Chosewood reads, As Employers, Protecting and Improving the Mental Health of Workers More Vital than Ever. Focus first on primary prevention: improve the conditions of work ...but also offer secondary and tertiary services. Establish organizational goals to measure, understand, and improve MH. Encourage social connections at work; value peer-led interventions. Invest in/improve training of front-line leaders/managers. Provide a seamless connectivity to care when needed. Use operational measures and metrics to gauge and act upon challenges. Ensuring privacy and confidentiality remain vital.

(SPEECH)
As we end, let's talk a little bit about the role of mental health and work. Focusing on primary prevention means resilience programs are not the answer. Those are secondary or tertiary at best.

Primary prevention means creating the space where mental health conditions cannot develop. That is possible. Yes, there are going to be some baseline regardless, but work is a strong predictor of mental health outcomes.

Making sure your organization measures these things on a regular basis. Invest and improve the skills of front-line managers. In the Q&A, we'll talk a little bit more about the role of front-line managers.

And measure these things. If you don't measure it, you won't know where you need to intervene and where your challenges are. And then, as always, when you're mixing work and non-work issues, privacy and confidentiality are important.

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In a photo on the next slide, a girl smiles behind Dr. Chosewood, her arms around his neck. A younger girl beside him puts her pinky and ring finger in her mouth.

(SPEECH)
This is Lily and Embry, my two granddaughters. And yes, I know I'm too young to have granddaughters. [AUDIENCE LAUGHS] They give me, though, a lot of hope and optimism for the future, and I want to leave you with that note, as well.

I believe that this country still has its greatest years ahead of it. I still think there's great opportunity for us to have jobs that mean something to us, provide a living and a life, and I'm convinced that with your leadership and with good policies from both the workers compensation and insurance space, but also the occupational health and safety space, together we can get there. Thanks very much.

(DESCRIPTION)
Text, Joan Woodward, President, Travelers Institute, Executive Vice President, Public Policy, Travelers. Three tufted chairs sit on stage behind and to the right of Joan. Dr. Chosewood sits in the right-most chair. The screen behind her reads, Be Risk Ready: What's Trending in Total Worker Health (registered trademark). Wednesday, May 3, 7:15 to 8:30 a.m. E T., Atlanta, Georgia. Constitution State Services. Travelers Institute. Travelers.

(SPEECH)
JOAN WOODWARD: Now I'm pleased to introduce our other panelists-- Scott Humphrey, my colleague at Travelers. He manages a team of about 30 people who oversee the delivery of the Travelers Risk Control Service to National Accounts, loss-sensitive insurance customers, and very large Middle Market accounts, as well.

(DESCRIPTION)
Scott comes on stage and shakes hands with Dr. Chosewood before taking the middle seat.

(SPEECH)
He's over 30 years at Travelers. I know he doesn't look that old either. None of us do, frankly.

Scott predominantly focused on consulting directly with customers and helping them understand and manage their risk, in particular, ergonomics, behavior-based safety and injury management. So, I know we have a lot of customers in this audience today, and I know a lot of you have had the benefit of Scott's time. So Scott, I'm going to sit down with the panel, but talk to us first about the role of the insurance industry when it comes really to worker or health, and tie it back into what Dr. Chosewood presented to us this morning.

SCOTT HUMPHREY: It was very interesting, and the conversation that Dr. Chosewood just had with us leads exactly into the points that I want to make.

(DESCRIPTION)
Text, Scott Humphrey, Assistant Vice President, Risk Control, Travelers. Joan takes a seat next to Scott.

(SPEECH)
Excuse my voice. I think it's allergies.

When you think about-- and I'm sure everybody in this room would have a story as to how they add value to the insurance industry. I'm going to focus it just on workers compensation. And when I think of that, I think everyone is trying to, in our industry, maintain-- help customers to maintain a healthy workforce. The workforce is definitely stressed, as you just heard.

So in Risk Control, we try to do is help customers to prevent accidents and manage their injuries. That's sort of the key to what we do. And essential to that is management engagement.

Management defines the environment and the culture in which the employees work. So they create—identify the safety rules. They encourage safe work practices. They demonstrate an overall concern for the employees’ well-being. So all of that helps to prevent accidents, minimize injury costs and retain good employees.

The key—or, I should say, integral to management engagement is that front-line supervisor. They are the key to how the employees feel about their employer. So they are critical to maintaining a safe work environment.

When you think about the front-line supervisor, and any of you that are customers of ours in here, the front-line supervisor is the one that onboards that employee. They maintain the safe work environment. And if the employee gets injured, they’re the one that’s going to respond to that injury. So they are a primary focus of the services that Risk Control offers from an insurance perspective to our customers. So the front-line supervisors are critical to this, and it’s all about management engagement to maintain and achieve that healthy work environment.

JOAN WOODWARD: Thank you. So Dr. Chosewood, I want to dig in this a little bit, because you had said in the past, I think on our webinar a little while ago, that your front-line manager has more influence over your health than your physician—than your physician. And so let that sink in for a minute, folks. Explain your thinking there.

L. CASEY CHOSEWOOD: Sure. Thanks, Joan. Couldn't agree with you more. And if you think about it, the amount of time you spend with your physician each year-- maybe two 15-minute visits, if you're lucky, a little bit more than that-- that influence is pretty small, right? But in contrast, somebody who's with you every day making decisions about when you come to work, when you get home, how much time you have off, when you go to bed, determining strongly your pay. We know that wages are a very powerful predictor of many, many health outcomes, perhaps one of the strongest. Your opportunities for advancement, and the climate in which you live in, which you breathe in.

We know based on our look at stressful jobs versus not that about 25% of heart disease in this country has a strong work association. The leading cause of death, WHO says 25% of heart disease in this-- among workers is work related. That tells you how powerful the influences of work are each and every day.

Work is a very strong-- we call it a meta-determinant of health. Yeah, income is important, but work influences that, right? How much sleep you get is important as a determinant of health, but work influences that. It is so powerful across so many areas that our research shows whether you're looking at dollars, days of absence or injury, all of those things, the front-line manager has most of the power and control.

And sadly, many of them don't have enough training and resources to be able to do a good job in this space. So a lot of our efforts are focused on upskilling, increasing the healthier supervision from that front-line management team.

JOAN WOODWARD: And a lot of times, front-line managers, they're not trained in being a psychologist, or they're not trained. And we don't train our front-line managers to have to help workers realize what they're struggling with sometimes. More employee training of that.

So Scott, let's go to you because you see this every day in your job in Risk Control, overseeing. What are some of the successes that you've worked with certain businesses, large or small businesses, in Risk Control? Talk about that for a minute.

SCOTT HUMPHREY: Okay. I'm going to focus on an example that has to do mainly with reducing loss costs, but it aligns very well with what is the response of that front-line supervisor? So we have a variety of perception surveys that we use with customers to help them identify gaps in their risk management programs. Our post-injury management survey has about 6,000 respondents. And to the question on the survey, my employer has provided me information on workers compensation, less than 25% agree with that statement. So there's a big opportunity to educate employees on what's going to happen if I have an injury.

So in the absence of the employer providing that guidance, the employee is going to look elsewhere. And through our interviews, as a part of this process we learn that they turn to, as you could imagine, family, friends, coworkers and attorneys. And while everyone may mean well, there can be misinformation provided.

So what we do is work with customers to help them establish that communication. What is the benefit to the employee, and exactly what are you going to do if there's an injury? So including conveying to the employee that if you are injured, we want you back to work. We will offer you transitional duty. We will have a job for you until it's medically appropriate for you to return to full duty.

So the more information, I think, that the employer provides on that benefit, and what's going to happen when an injury happens, the more informed is the employee, and the better or the smoother their return to work is. So it seems like a relatively simple approach, but it can have a significant impact on loss costs.

JOAN WOODWARD: So what percentage would you say, just generally speaking over the last couple of years where it has changed, what percentage of employees who do a workers comp claim don't come back to work, or come back in a more limited way just generally speaking? Has that evolved in the last 10 years or so?

SCOTT HUMPHREY: I think companies that have well-defined processes for managing those injuries and responding to an employee, you're going to see a much better, higher return to work. I know there's a lot of dynamics with what Dr. Chosewood said that I do think employers need to be thinking about. I know our claim department has got a number of things that they're trying to apply that relate to mental health.

L. CASEY CHOSEWOOD: Right.

JOAN WOODWARD: So let's talk about, back to Dr. Chosewood, about this quiet quitting. Because during the pandemic, I think we all rethought our lives. We're sitting at home thinking, what am I doing with my life? And so a lot of people did quit their jobs and did not go back to maybe a dead-end job.

The Small Business Administration has fantastic figures that during the pandemic, obviously, a lot of small businesses went out of businesses. But creation of new small businesses-- it's Small Business Week, by the way-- creation of new small businesses in this country was at an all-time high. So this quiet quitting you talk about, did some of those people start small businesses? Did some of those people go into business for themselves?

L. CASEY CHOSEWOOD: Yeah, I think there was this big reexamination of our relationship to work-- partly because it was forced. A sizable number of people lost a job, so they had to think in new terms of earning a living. You might have heard the “great resignation,” where people are oftentimes just jumping from one job to another for a slightly bigger pay. We saw quite a bit of that early on.

That's settled down. We don't see that as much. One side effect, though, of the pandemic is wages have gone up dramatically. You might have noticed that. Just like inflation of everything, wage inflation has occurred, as well. There are positives to that.

Home Depot just decided to invest $1 billion to increase the wages of all their front-line people. Saying that if we pay our people more, they're more likely to serve our customers better and be more engaged in-- and we won't lose them. They won't jump from service job to service job.

Quiet quitting, some of my friends tell me they've been quietly quitting for a long, long time. So it's not necessarily new. It's also called minimum Mondays, what I can do to just barely get by on Monday.
For us, it really comes down to this issue of engagement. Are people seeing the importance of their work? Does it mean something to them, and do they actually feel like work is producing something positive-- more than a paycheck?

People will be far more likely to leave a job not over pay, but over relationships-- largely front-line supervisor, but also coworkers. If you have a toxic coworker can be really negative. So rooting that out early, important in those settings.

The other important thing I'd say is many people say their best friend in life is someone who works with them. We need to be encouraging that every single step of the way. That is such a nice mediator for some of these challenges of workplace stress and disengagement. If you have somebody who cares about you on a very personal, intimate level who also works with you, your work satisfaction goes way up. Most programs do not encourage that collegiality to the extent they can.

JOAN WOODWARD: Actually, Gallup has-- how many people in the audience have had the Gallup engagement survey done at their offices? So you don't even have to spend lots of money and call Gallup in. You can just do this yourself because Gallup comes in, they do an assessment of how engaged your employees are, and you'd be surprised how disengaged some of-- actively disengaged some people in your workforce are.

You think they're engaged, but they're actively disengaged. And this Gallup poll showed us that if you had a best friend at work, that was the No. 1 predictor of if your employee is going to be engaged. Having a best friend at work.

L. CASEY CHOSEWOOD: Completely agree. Yeah, and this active disengagement means that they're actually sabotaging the success of the business.

JOAN WOODWARD: Active disengagement.

L. CASEY CHOSEWOOD: Right, it's a highly negative thing, and it's also contagious. One person can really contaminate the attitude of so many others. In the EAP world, the employee assistance space, they have this saying that in any organization, there are a handful, maybe two, three, four, five of people who are responsible for most of the stress in that organization. And if you do not know who they are, you're one of them, okay?

[LAUGHTER]

JOAN WOODWARD: You're one. That's cute. We're going to take some audience questions, and I think we have some microphones in the room circling around. So who has a question for Dr. Chosewood or Scott about, obviously, our risk control experts up here on the panel?

L. CASEY CHOSEWOOD: And while we're waiting for the next question, I can give you a quick update on what things are like at CDC right now.

JOAN WOODWARD: Please do.

L. CASEY CHOSEWOOD: Yeah, yeah. We're happy that we had a very easy flu season. It was early and hard. So we had a really spike around November that's died off nicely, so flu season is over. The RSV, the respiratory syncytial virus surge we had early on was quite worrisome. That was sort of a confluence of early flu, RSV and COVID all at once-- quite worrisome.

A lot of pediatric hospitalizations. That's because largely kids had sheltered in place like the rest of us for a couple of years. And then when they went back to school, to daycare, out and about, we had a really high surge of RSV. Most kids get it in the first year of life. But all of those who went through the pandemic did not. And then we had a double dose, if you will, of RSV. So a shortage of pediatric hospital beds.

Luckily, all three of those looking much, much better. Community levels of transmission of COVID are down. We're still following monkeypox-- not so much in the U.S., but globally, it continues to be a problem. That's a public health success story. The vaccination campaign in those at risk, very successful.

We're watching the train derailment in Ohio. We're watching the fungal outbreak of blastomycosis in mill workers in Michigan. One hundred three people sick at one company, 13 hospitalized and one death. This is a very rare fungal condition. We have people on the ground now trying to figure out what's going on.

Globally, there are also still some Marburg virus and Ebola that we're monitoring. We have 22 people deployed to Africa now looking at those issues. So it's an active-- CDC is always busy, but trying to stay on top of things to keep people safe.

JOAN WOODWARD: Wow, that's really interesting. I want to ask you just a question. Obviously, a lot of us have got the vaccine, and we got the booster. We got the next booster. So where do we stand, and please raise your hand if you have a question. We want to get the microphone to you while we're answering. Anyone have a question out there? OK.

So if we've had boosters, where does it stand now in terms of getting another booster? So if I'm six months beyond my last booster, should I get another one or not? And is it for different populations, maybe those who have immune disease versus just someone who doesn't.

L. CASEY CHOSEWOOD: You are exactly right. For most of us, if you've had at least one of the bivalent Omicron-specific vaccine, the most recent variety of vaccine, at least one, you're considered up to date and fully immunized. And you do not need a second booster. There are some populations-- those with severe chronic conditions, decreased immune system, and those over 65-- age 65 who should consider and discuss with their doctor the need for a second booster of that same type.

But CDC has simplified its vaccine recommendations now. So even if you've never been vaccinated, only one of the most recent doses, the bivalent Omicron-specific vaccine, is only required to be fully immunized at this point. That's largely a reflection of how broad coverage it provides, but it's also a reflection of the low level of risk in the country right now for infection and the fact that we have such widespread immunity because of previous infection or vaccination.

JOAN WOODWARD: OK, great.

(DESCRIPTION)
Joan gestures to a man standing with a microphone in the audience.

(SPEECH)
Question over here. Yes?

(DESCRIPTION)
Text, What can be done about the public distrust and what is being done to prepare for the next pandemic?

(SPEECH)
L. CASEY CHOSEWOOD: Thank you for that. I appreciate-- I didn't plant that question honestly, but it's an excellent one. And I do feel very strongly that the public health community has taken a hit, perhaps in some ways deserved, because we always know that we could do better, and we are committed to doing better in future outbreaks and future responses.

We're working, really, on three things. One, increasing the speed that we collect data so that we can make better decisions. Unfortunately, the federal government does not have the authority to demand data collection of anyone, right? We have 50 states, each with their own laws, and most of the states collect their own data, and then, because of agreements and close working relationships, send that to CDC for collection. But there are very few mandated reporting requirements when it comes to disease, so we rely on the 50 states cooperating with the federal government to supply data in a timely manner.

Next, though, in addition to getting faster data, we want to make better and clearer decisions and communicate those more quickly. Like many of you, I was frustrated that things kept changing. Yes, a mask today. No, a mask-- you know, how many masks? What type of mask?

How many vaccines do we need? That information creates chaos when there's not clear, concise communication. So we're working very quickly, very strongly on trying to streamline any future communications.

And then lastly, continuing to understand the importance of partnerships. This cannot be top-down. It really needs to be all of us engaged together. People trust local sources of information in general, including from their own employer, more than they do from the top down.

I mentioned the campaign that we're rolling out for health workers. They made it very clear to us, we don't need this information coming from CDC. We want it to come from our own management team because that not only is where the rubber meets the road, but we need to know that they understand the issue and they're engaged and committed to doing something about it. So we're going to continue to build those on-the-ground partnerships, better develop our network so that we can do a better job next time around.

Resource is always an issue, you know. I am paid by your tax dollars, and thank you for that, but we are also looking for better ways to use technology, artificial intelligence. We scan Google every day to see what people are searching for. We know what health conditions are being searched.

And if there's a blip in any symptom, or condition, or issue, or complaint, we're on that right away. So we're committed to using the best technology to track the challenges and symptoms that Americans are facing, and we'll continue to do that. But thank you for bringing that issue up.

JOAN WOODWARD: You know, a lot of people-- I worked on Capitol Hill for a lot of years, and a lot of people say, when you present a government person to give a speech or whatever, we're from the government, we're here to help you. A lot of people are very skeptical. And this time in our political arena, too, it's gotten too political.

And so we're so grateful to have you help us at Travelers, and this is the kind of thing we're doing with the Travelers Institute is to partner with government agencies to bring in more thought leadership and expertise to inform not just writing another workers comp policy. It's about understanding the trends that are happening in today's world to help our customers. So Scott, I don't know if you had something else to say on that one, or any other audience questions? All right, let's go one more question here.

(DESCRIPTION)
Text, Has the medical community seen a relationship between working from home and mental health?

(SPEECH)
L CASEY CHOSEWOOD: Yeah, wonderful question. Some really good data coming out on that. So who does better, people who work at home all the time, people who work in the office all the time, because we just talked about coworker support being valuable, or people who mix it up? The best mental health is reported in those who have the flexibility to either work from home or in the office. So a mix of both has the best mental health outcomes according to the most recent data.

Second place are those who work on-site full time. And last place when it comes to mental health are those that only work remotely. They have the lowest level of reported mental health. Meaning best mental health, those who have the flexibility to do both. Second place, those who work on-site full time. And worst mental health outcomes in those who are remote workers only.

There is something to be said for social isolation, for loneliness, for that disconnect. We're social beings. That is how we evolved. And remote work, even though it has benefits, mental health does not seem to be one of them.

(DESCRIPTION)
The screen behind the speakers reads, Wednesdays with Woodward (registered trademark) Webinar Series. Upcoming Programs: Webinars: May 3 - A Small Business Playbook for Leading Through Uncertainty. May 17 - Previewing the 2023 Travelers Championship. May 24 - The Rapid Rise of Litigation Costs. June 7 - The How and Why of D and I. In-Person Programs: May 23 - Cyber: Prepare, Prevent, Mitigate, Restore (Charlotte). Text above a QR code on the screen reads, Register.

(SPEECH)
JOAN WOODWARD: OK, before we get to the next question, we do have a QR code up. So do take your phones out. I know usually you say put your phones away and turn off, but go ahead and scan this QR code. And we're going to ask you for your email. I know we have your email, but sign up for our webinar series because we bring a lot of thought leaders in from the government and other places in the industry.

I'm just going to run down the next upcoming programs that we're going to have on our webinar series. Today, actually, we're having a webinar about small businesses. So I have one of the heads of the Small Business Administration talking about managing risk for smaller businesses. If you're a golf fan, on May 17 we're going to go behind the scenes of a PGA TOUR event, the Travelers Championship.

May 24, we're going to look at litigation cost-- the rising-- rapid rise of litigation costs in our businesses. And then on June 7, we're going to sit down with our Travelers Chief Diversity Officer. So you're welcome to join. They're all free and open to the public and to the press.

Do we have another question before we let anyone else-- any other questions out there, Cass? I want to make sure we include everyone. One more question, and then we're going to wrap it up.

(DESCRIPTION)
Text, Are there enough mental health professionals ready for the coming needs of the future?

(SPEECH)
L. CASEY CHOSEWOOD: Sadly, no. There is a dramatic shortage in mental health professionals, especially those with specialty in the workplace setting or understanding the challenges that workers face. I spoke at the National EAP Association, and they told me they're seeing two trends. One, this loneliness and social isolation that I talked about. But at the same time, they're seeing people struggle with social anxiety returning to work.

So it's this kind of two sides of the same coin. I'm not comfortable being alone, but I'm worried and nervous about my resumption to normal life. So that's just an example of how increased demand we expect to continue.

There's a significant shortage of mental health professionals. Many of them are older, nearing retirement without enough coming into the profession. The other thing I'll mention is that we're seeing a little bit of moderation of that challenge because of online services. Both artificial intelligence counseling, so machine-based, natural language counselor available. Real time--

JOAN WOODWARD: What are your thoughts on that?

L. CASEY CHOSEWOOD: Yeah, pretty crazy, huh?

JOAN WOODWARD: Yeah, we just did a webinar on ChatGPT® for the insurance industry. Go back and watch it if anyone has seen it. It's on our replay list at the institute. But what is your thought on mental health artificial intelligence?

L. CASEY CHOSEWOOD: You know, my training as a family medicine physician wants to just run the other way as quickly as I can because there's something about sharing your most intimate life struggles and worries to a machine, it just doesn't feel human, right? It doesn't feel like that could possibly be beneficial.

The truth is some of the research shows that for people with mild symptomatology, talking to a chatbot, if you will, is quite effective. It's partly helping people, I suppose, talk to themselves, talk through some of their challenges. So I could see value there.

But there's hardly a replacement for someone to hold your hand, or someone to empathize with you, or make a true human connection. I think that's why friendships and colleagues, close relationships with colleagues is so important. So while we were worried about people in low-skilled jobs having their jobs replaced, now artists are concerned. You know, like music creators, and painters, and digital creators are worried about artificial intelligence replacing them. So really, highly skilled creative jobs being overtaken by artificial intelligence is quite interesting.

JOAN WOODWARD: I'm going to call out my colleague Rich Ives. Are you still in the room, Rich? Can you stand up for a minute and give my-- Rich, this is not planned, but I'm going to give Rich one minute in closing remarks because we have an app, right, for Travelers customers on mental health.

RICH IVES:

(DESCRIPTION)
Rich stands at the back of the room with a microphone. Text, Rich Ives, Vice President, Workers Compensation, Travelers.

(SPEECH)
Yeah, we do. And part of our research over the last couple of years has shown that 40% of injured workers who are losing time from work actually have a complicated recovery situation due to a mental well-being situation. So we've been able to quantify it. We know that the outcomes are certainly worse when they do.

That put our focus on developing an app called WiSA for return to work. And like you just mentioned, Dr. Chosewood, if someone really needs psychological treatment, there's no replacement for that. But this actually provides mental well-being support or aids.

So it is an application that can be downloaded. It is a virtual chat powered by AI customized for the workers compensation use cases to provide things like reframing exercises or sleep aids and the like. And we've seen a remarkable reaction. Almost all of the injured employees who use it say that it made them feel better and it helped their recovery. And of those who use it, 30% betterment in return-to-work outcomes is what we've seen. So we know it's beneficial and helpful.

JOAN WOODWARD: Thank you, Rich. Sorry to call you out unexpectedly, but I knew you had the answer on that one. So listen, a couple of things. One, as Bill mentioned, we value our customers. We actively engage experts outside of Travelers to help our customers when we can, so this is just a small example of what we do at the Travelers Institute. And we're just so appreciative. Please join me in giving round of applause for our terrific panelists today.

[APPLAUSE]
It's so good.

(DESCRIPTION)
Joan gestures to Dr. Chosewood.

(SPEECH)
And he didn't even have to leave home. He lives in Atlanta, so it's the perfect thing--

L. CASEY CHOSEWOOD: There you go. Made it easy.

JOAN WOODWARD: --to have rooms in Atlanta. Bill, anything else before we close it out? OK, again, thank you so much. Enjoy your conference. Oh, visit us at booth number 2217 for the Constitution State Services partner with Travelers, and thank you all so much for your business.

(DESCRIPTION)
Text, Travelers. The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries.