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

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]