Column: Workers' Comp

Can We Walk the Advocacy Talk?

By: | May 2, 2017 • 2 min read
Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

It’s impossible to avoid recent talk calling for increasing injured-worker advocacy and engagement by treating injured workers with more compassion and empathy.

It remains to be seen, however, whether taking a softer, more supportive approach to injured workers is just talk. Or will the philosophy take hold across the workers’ compensation industry, significantly reshaping claims management practices, such as slashing the percentage of claims referred for investigation and litigation?

Accompanying the argument for greater injured-worker engagement is the idea that the vast number of workers’ claims are legitimate, with employer-premium fraud and provider fraud being much bigger problems.

So why not spare the valuable resources spent chasing the tiny percentage of cases involving workers attempting to bilk employers?

Why not shift the attention to improving claims outcomes overall by engaging injured workers who need a paycheck as much as employers need them back on the job?

This is not an argument for eliminating all worker-fraud investigations. There are cases needing prosecution.

But it is a call for reexamining claims-management philosophies, re-evaluating which practices to emphasize and reshaping how injured workers are thought of.

The discussions about injured-worker empathy and engagement in the workers’ compensation arena are hard to miss, meanwhile.

Why not shift the attention to improving claims outcomes overall by engaging injured workers who need a paycheck as much as employers need them back on the job?

A recent newsletter from a major broker, for instance, recommended training managers in listening and showing empathy as a strategy for reducing workers’ comp litigation.

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During the 2016 National Workers’ Compensation and Disability Conference® & Expo, keynote speaker Tim East, a director of corporate risk management at The Walt Disney Co., encouraged claims payers to focus on advocating for injured workers.

And a workers’ comp practice leader at a major third party administrator, as another example, recently spoke to me at length about his organization’s adoption of “a culture and philosophy around caring.” He did this when I called asking about difficulties establishing injury causation.

And yet, those in a position to know have not seen a decline in claims referred for investigation. Court cases also reveal plenty of examples of claims payers, perhaps needlessly, pursuing injured-worker fraud.

A Louisiana appeals court, for instance, recently found for a worker who sold a horse for $3,500 while receiving workers’ comp benefits. His employer and the employer’s insurer argued the 76-year old committed fraud by claiming he had not received any income.

The courts believed the worker’s argument that he bought the horse 19 years earlier for $20,000 and that raising horses was a hobby. The insurer’s claims adjuster admitted at trial that had the claimant earned money from a garage sale it would be immaterial to his workers’ comp claim.

The claimant won attorneys’ fees for both trial and appeals court expenses.

Such outcomes do raise questions about the resources spent pursuing fraud.

Some leading-edge employers have shifted to emphasizing injured worker advocacy, and their claims service providers are espousing the philosophy.

But it will take time before we really see whether a system bias favoring fraud investigations is widely replaced by an advocacy approach. &

More from Risk & Insurance

More from Risk & Insurance

Risk Management

The Profession

Pinnacle Entertainment’s VP of enterprise risk management says he’s inspired by Disney’s approach to risk management.
By: | November 1, 2017 • 4 min read

R&I: What was your first job?

Bus boy at a fine dining restaurant.

R&I: How did you come to work in this industry?

I sent a résumé to Harrah’s Entertainment on a whim. It took over 30 hours of interviewing to get that job, but it was well worth it.

R&I: If the world has a modern hero, who is it and why?

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The Chinese citizen (never positively identified) who stood in front of a column of tanks in Tiananmen Square on June 5, 1989. That kind of courage is undeniable, and that image is unforgettable. I hope we can all be that passionate about something at least once in our lives.

R&I: What emerging commercial risk most concerns you?

Cyber risk, but more narrowly, cyber-extortion. I think state sponsored bad actors are getting more and more sophisticated, and the risk is that they find a way to control entire systems.

R&I: What is the riskiest activity you ever engaged in?

Training and breaking horses. When I was in high school, I worked on a lot of farms. I did everything from building fences to putting up hay. It was during this time that I found I had a knack for horses. They would tolerate me getting real close, so it was natural I started working more and more with them.

Eventually, I was putting a saddle on a few and before I knew it I was in that saddle riding a horse that had never been ridden before.

I admit I had some nervous moments, but I was never thrown off. It taught me that developing genuine trust early is very important and is needed by all involved. Nothing of any real value happens without it.

R&I: What about this work do you find the most fulfilling or rewarding?

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Setting very aggressive goals and then meeting and exceeding those goals with a team. Sharing team victories is the ultimate reward.

R&I: What is the most unusual/interesting place you have ever visited?

Disney World. The sheer size of the place is awe inspiring. And everything works like a finely tuned clock.

There is a reason that hospitality companies send their people there to be trained on guest service. Disney World does it better than anyone else.

As a hospitality executive, I always learn something new whenever I am there.

James Cunningham, vice president, enterprise risk management, Pinnacle Entertainment, Inc.

The risks that Disney World faces are very similar to mine — on a much larger scale. They are complex and across the board. From liability for the millions of people they host as their guests each year, to the physical location of the park, to their vendor partnerships; their approach to risk management has been and continues to be innovative and a model that I learn from and I think there are lessons there for everybody.

R&I: What is the risk management community doing right?

We are doing a much better job of getting involved in a meaningful way in our daily operations and demonstrating genuine value to our organizations.

R&I: What could the risk management community be doing a better job of?

Educating and promoting the career with young people.

R&I: What have you accomplished that you are proudest of?

Being able to tell the Pinnacle story. It’s a great one and it wasn’t being told. I believe that the insurance markets now understand who we are and what we stand for.

R&I: Who is your mentor and why?

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John Matthews, who is now retired, formerly with Aon and Caesar’s Palace. John is an exceptional leader who demonstrated the value of putting a top-shelf team together and then letting them do their best work. I model my management style after him.

R&I: What is your favorite book or movie?

I read mostly biographies and autobiographies. I like to read how successful people became successful by overcoming their own obstacles. Jay Leno, Jack Welch, Bill Harrah, etc. I also enjoyed the book and movie “Money Ball.”

R&I: What is your favorite drink?

Ice water when it’s hot, coffee when it’s cold, and an adult beverage when it’s called for.

R&I: What does your family think you do?

In my family, I’m the “Safety Geek.”

R&I:  What’s your favorite restaurant?

Vegas is a world-class restaurant town. No matter what you are hungry for, you can find it here. I have a few favorites that are my “go-to’s,” depending on the mood and who I am with.

If you’re in town, you should try to have at least one meal off the strip. For that, I would suggest you get reservations (you’ll need them) at Herbs and Rye. It’s a great little restaurant that is always lively. The food is tremendous, and the service is always on point. They make hand-crafted cocktails that are amazing.

My favorite Mexican restaurant is Lindo Michoacan. There are three in town, and I prefer the one in Henderson as it has the best view of the valley. For seafood, you can never go wrong with Joe’s in Caesar’s Palace.




Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]