Trucking companies, drivers and the general public who share the road with trucks would all benefit from an approach that treats truck driver health as an ongoing project rather than every-other-year paperwork – and the new National Registry of Certified Medical Examiners could be a step in that direction.

That was the message of Dr. David McKinney at the Fleet Safety Conference in June.

Founder of California Occupational Medical Professionals, McKinney has been involved with the development of the registry, which is now active. By May 21, 2014, all drivers must use a professional from the registry to conduct their physicals and get their medical cards.

While regulations have for some time required a medical exam to determine a driver’s physical qualifications to operate a commercial motor vehicle, “We found out that getting this exam done and done properly was problematic to say the least,” McKinney explained. “Oftentimes family physicians or urgent care physicians would do these exams as an afterthought, so driver certification became very hit and miss. This has become more of a problem as time has gone on.”

Adding to the problem, he said, was the practice of doctor-shopping, where drivers who failed to get a medical card from one doctor would simply try different ones until they succeeded.

“There are certain examiners people seek out because they’ll pass anybody,” McKinney said.

With the new registry, not only will medical professionals have to pass an exam showing they understand the medical demands of truck driving, but they also will have to input the results of each physical conducted into a national database. Those exam results -- when the exam was done, whether the driver was certified qualified, unqualified, or temporarily disabled, and restrictions and variances -- will be available to the next examining physician.

One potential problem is that come next May, there may not be enough certified examiners to handle the workload. McKinney recommended that fleets develop a relationship with several certified professionals ahead of time.

In addition to making sure they have someone to do the exams, that relationship also can help fleets move drivers more toward a program of true wellness rather than simple medical certification. It’s no secret that the lifestyle of trucking is not conducive to good health, with its sedentary nature and lack of access to healthy foods.

“I know of no organic food bar that has parking spaces for truckers,” McKinney quipped.

However, he also pointed out a factor that gets less attention: The very nature of the high level of alert that professional drivers need to maintain is a stresser that leads to health problems.

“One of the biggest stressers is the ability to stand ready,” McKinney explained. “We take fire departments that don’t have a lot of action, like airport fire departments, yet we note the rate of heart disease and hypertension is higher than the general population, because there’s this constant state of readiness. Driving can be analogized to this. There’s a lot of responsibility, a very demanding situation.”

All these factors lead to an increasing prevalence of serious disease in commercial motor vehicle drivers, he said. The big four are:
• Hypertension,
• Type 2 diabetes,
• Cardiovascular disease, and
• Sleep apnea.

“To some extent this mimics the general population,” he said, “but it is somewhat more prevalent and has special significance for those driving trucks.” No one wants a driver to have a heart attack or stroke, fall into a diabetic coma, or fall asleep behind the wheel of an 80,000-pound truck.

McKinney noted that the Federal Motor Carrier Safety Administration will soon be releasing new “guidance” for medical examiners about screening truck drivers for sleep apnea, which will likely look at body mass index among other factors. Although the “guidance” does not have the force of law, “once the registry comes into effect, examiners are going to have less leeway,” he said.

McKinney views the FMCSA’s increased focus on driver health as a chance for the industry to take a more proactive approach.

“I think going forward there’s a real opportunity here for the industry and medical examiners to really affect driver health,” McKinney said. “Instead of just passing the exam to get your certification, focus on driver health and managing their medical problems so we keep them certified.

“Really what we’re looking for is to keep drivers healthy, fit and driving. That’s going to require more work on your part and on the doctor’s part.”
He said fleets can require drivers to have a more comprehensive “fit for duty” exam than is called for in the federal regulations, to help identify at-risk drivers and address their health issues.

McKinney, who is also a certified flight surgeon for the Federal Aviation Administration, said this is already the approach he takes with pilots.
“That’s the way I treat my pilots who are at risk,” he said. “I see them more frequently than their certification requires. I carry on a relationship with them and their company way more than required by the FAA, so when certification comes up, we’ve already addressed issues such as high blood pressure, so I sign their card and they go off into the wild blue yonder.”

Why CSA may raise your insurance costs

Many insurance underwriters, happy to have a new data source, are putting too much emphasis on CSA scores when it comes time to writing policies. This could mean higher premiums, higher deductibles and some underwriters who won’t even consider insuring your company, said John Simms, vice president with HNI, in a session at the 2013 Fleet Safety Conference.

HNI is an insurance broker and safety consulting firm that helps companies improve their safety programs in order to help them get the best rates from the underwriting community.

“Premiums are on the rise and a lot of that is being attributed to CSA,” Simms said, noting that the American Transportation Research Institute’s annual cost per mile study found truck insurance premiums in 2011 were up by 8 cents per mile from the previous year. He predicts you’ll see a radical increase in 2012 as well. “We’ve seen deductibles jump from $10,000 to $200,000.”

If you have no more than one CSA alert and a good loss ratio, underwriters will be happy to work with you, Simms said. However, “carriers with two or more CSA alerts are considered ineligible risks for a number of underwriters, regardless of loss ratio or the number of years they have been with the insurance company.”

Insurance underwriters are determined to use all available information, public or private, to decide whether to insure a risk and what the pricing should be, Simms said. CSA brings a new source of information.

“As a result, CSA data is receiving intense scrutiny by underwriters and now plays a disproportionately large role in the consideration and pricing of your risk,” he explained. “Underwriters believe that the data from CSA can significantly impact the financial outcome of liability claims. Bad CSA data means higher claim settlements, which means [the insurance company is] going to pay out more in claims, which means you’re going to pay a higher premium.”

There are several ways your CSA information can be misinterpreted by insurance writers, Simms said. Many underwriters simply don’t understand the methodology of CSA and the SMS system. That’s why it’s important to work with your underwriter to help make sure they’re using it correctly.

“Make sure your underwriter understands your numbers,” he said. If a deeper look at your scores shows they are trending downward (and in CSA scores, like golf, lower is better), make sure the underwriter’s aware of that trend.

If the trend is upward, you’d better get busy on a plan to improve it.

“If you have active alerts, what is your improvement plan?” Simms said. “Be specific and show you mean business.”