Humanizing Workers Comp Claims

 
 

Humanizing Workers Compensation

In workers compensation, we often look at things from the business perspective: “How can I save money and time?” This approach usually results in doing the right thing for our employees, but sometimes claims need a human touch. Often, the better questions are: “How can I provide humane medical care for my injured worker and get him or her back to work sooner? Can I offer more than the bare minimum and become the ‘employer of choice’ in this area?”

The following are two case studies. Only the names have been changed.

Angela Greenwood, 59, was a model employee, working in sales and generating hundreds of thousands of dollars in revenue for her company until one icy day when she slipped outside the office door and hit her head—hard.

Post-injury response errors multiplied. Because no one told her what to do, she drove herself to the wrong hospital, which was not prepared to handle a brain injury. She was given the wrong form and wrong insurance information, delaying treatment. She now suffers from traumatic brain injury, which may have been prevented if she was promptly treated at the right location. Three years later, her claim is still not settled, and she hosts a consumer blog for victims of workers compensation, pointing out the faults of her former employer.

Andrew Campbell, 37, was driving home in a downpour after a business trip. Visibility became so bad that he pulled over under a bridge, where he was struck from behind. After recovering from the loss of his spleen, he returned to work, but something was not right. Campbell, an accountant,  made some costly errors and was demoted. Soon, seizures at work forced him to take time off and, after three months, his employer eliminated his position, implying there was no work to come back to.

Campbell not only sued the insurance company, but also hired an employment attorney to get his job back. He won three years’ worth of back pay, and the employer had to reopen his position, pay both sides’ legal costs and cover the now-overdue medical bills. As the employer strung him along, the attorney bills piled higher, increasing costs even more.

Consider the employee’s predicament: Seriously injured employees cannot accept a settlement offer until they know the extent of their injuries and whether long-term care or training is needed. This is especially true with traumatic brain injuries, which can present symptoms up to six months after the original event, long after an employee has signed off on a settlement. On top of that, an untrained person may not even be able to recognize the symptoms, which can include talking about the same thing repeatedly (perseveration), being easily confused, getting lost when driving and forgetting personal information. Fatigue, poor judgment, inability to control anger and loss of the sense of smell are also common signs of brain injury.

Tips to Reduce Workers Comp Claims Expenses

  • Pre-plan for injuries by having a tight post-injury response procedure, offering instant, quality medical care.
  • Have a relationship with your local medical provider.
  • Make sure your injured employee knows you care.
  • Do not discourage claims. Set up your insurance to pay each claim quickly unless there is reason to believe it is not compensable.
  • Let your attorneys know you want legitimate claims paid promptly.
  • Details are critical. Dates, addresses and the list of approved providers must be up-to-date and accurate.
  • Give a wallet card to each employee with the telephone number for a 24-hour nurse service and require employees to call the number on the card as soon as possible after an injury. This can be helpful for business trips and gives the employee immediate feedback, shortening the time of the claim.
  • Make sure your insurance company is linked to your local medical provider. If insurance refuses to pay a claim, your employee could be denied treatment, which can cause a bigger, more expensive medical condition.
  • Give every employee information on workers compensation and make sure they understand it.
  • Provide ongoing professional development training for your human resources department or representative.
  • If you can afford it, implement a wellness program that includes simple pieces of information, such as the importance of sunscreen, tick bite prevention and response, and eye and hearing tests. This heightened level of awareness will have a positive ripple effect among employees.

The seconds after an accident determine whether the claim snowballs or is mitigated with proper medical care and employer ownership. That is why managers and supervisors must know exactly what to do when a worker is injured. Failure to communicate with an employee is what causes him or her to hire an attorney. More than that, humanizing your claims process treats people with respect while preventing cost-shifting to Medicare, unemployment and federal or state disability.

While prompt, excellent medical care is crucial, it is not the only thing. What would scenarios like these look like if the employer sent the injured worker a get-well card the next day, or if a supervisor suggested co-workers visit the employee at home? What if the risk manager set up the cost-containment program to make sure the best rehabilitation was provided instead of having all rehabilitation requests sent to utilization review to see if the number of days can be reduced?

A seriously injured employee needs immediate, paid medical care so he or she can get treated and return to work as soon as possible, sometimes in a transitional job until healing is complete. When tests and diagnoses are drawn out, the injured worker may be paying for them out-of-pocket, which could have very serious consequences for the average employee.

One of the harbingers of a nightmare scenario is the lack of a post-injury response procedure. Something as minor as the wrong date on an injury report can cause an insurance company to deny coverage, leaving the employee deep in debt with no medical resolution. Icy resolve  not to pay for certain procedures over certain dollar amounts, or at all, can morph into a claim that increases with time, eating up money along the way.

Give supervisors enough information so they can answer these questions: Where should the injured employee be taken for medical care? What insurance information do injured employees need to provide to the clinic when they arrive for treatment? Where is your company’s packet of procedures and forms kept? To aid in this process, some companies have triage service where a nurse is contacted at the time of an injury to determine the correct type of medical care. This speeds treatment and reduces the number of lost days dramatically.

Million-dollar claims are very rare, but when they happen, a quick, fair response is the best course of action. Our personal model must be one of compassion and patience even if our business model pushes for lower costs and quick resolution. Practicing compassion is not only the right thing to do, it is ultimately less expensive.

 
Rebecca Shafer

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About the Author

Rebecca Shafer is a consultant and attorney who runs LowerWC.com, which covers developments in the workers comp field.

Michael Stack

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About the Author

Michael Stack, CPA, is the principal of Amaxx Risk Solutions.

 
 
 

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