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Nurse Case Manager Chronicles

Empowering Injured Workers to Heal

Educating injured workers provides them with a sense of control over their care and their recovery.
By: | May 1, 2018 • 4 min read

An encounter with a patient early in her career as a case manager taught Lisa Armstrong a lesson that would influence her approach to all of her patients gong forward.

The case involved a worker who’d suffered a painful knee injury on the job.

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“He was a good, hard-working, blue-collar worker,” she said. He was dedicated to his job and his family and delayed seeking treatment, instead working with a bad knee. When the pain became too unbearable, he finally filed for workers’ comp.

“He had a meniscus tear,” recalled Armstrong, a nurse case manager with Genex Services, which specializes in medical management. “And after everything, his knee never quite returned to the way it was before.”

Armstrong went with the injured worker to a follow-up appointment. She sat in and listened as the doctor explained the injured worker’s options.

“The doctor was hesitant to suggest what he would recommend for another patient [who didn’t have workers’ comp].”

As a nurse, she was cognizant of medical solutions that would have helped in this scenario. The doctor could have suggested knee replacement surgery, but instead he did not mention it.

Armstrong speculated that the injured worker’s status as a workers’ comp patient caused hesitation, and “because of pre-existing osteoarthritis and because he was a workers’ comp patient,” Armstrong said the doctor most likely feared workers’ comp would not pay for the surgery and so did not recommend it.

Lisa Armstrong, nurse case manager, Genex Services

“But it’s not always about the claim. It’s about the person.”

Armstrong left the appointment feeling like she could do more.

“I felt like this patient needed empowerment.”

She spoke with the injured worker about knee replacement surgery, explaining it would be unlikely workers’ comp would cover it, but it was still an option he could pursue on his own. With Armstrong’s advice in mind, the injured worker had the surgery using his personal insurance.

“He was [planning] to live the rest of his life with a bum knee; now he can get back to work and be with his kids like before.”

It was a turning point for Armstrong: Empowering employees, giving them the information they needed to make their own choices, would be central to her case managing.

Building Trust

For Armstrong, who started her career as an acute care and rehabilitation nurse 15 years ago, the best thing nurses can do to ease the workers’ comp process is to build trust with injured workers. From that trust, empowerment will grow.

“An injury is an abrupt change of life. At the beginning, many don’t know which way is up.”

Armstrong speaks from experience. Her own daughter suffered a traumatic brain injury a few years back.

“I’m in the [medical] profession, and I was overwhelmed,” Armstrong said. “I can’t imagine what it’s like to not be a part of this [profession] and go through this type of event.”

Armstrong has a passion for educating workers during their transition from hospital to home. For her, case managing is both a healing process and an outlet to give back.

She said she was blessed with good people in her own journey; her hope is to help guide others.

“Sometimes a patient is left stumbling along in the dark. That first contact is important. It sets the tone [for the claim] early on.” — Lisa Armstrong, nurse case manager, Genex Services

Healing is a team effort, she added. Empowerment should be, too. Armstrong said when an employer shows they care about their worker’s needs, she’s seen more positive outcomes. Likewise, when a doctor talks to a patient and the insurance is accessible and responsive, workers tend to participate more in recovery.

Injury and illness of any kind can be scary. One day, a person is perfectly fine and the next it’s a slew of doctors, nurses, tests and monitoring. Add in the complicated world of workers’ compensation, and an injured worker can become overwhelmed and disheartened.

“The first contact a worker has after injury is their employer. I hear all sort of things, both good and bad,” said Armstrong. “Sometimes a patient is left stumbling along in the dark. That first contact is important. It sets the tone [for the claim] early on.

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“My heart is with trying to get a patient the education that they need,” said Armstrong. This education, she explained, extends beyond getting the patient home; it’s education that teaches them about their injury or illness and gives them a sense of control over their own health.

It’s the practice of empowerment — giving injured workers respect and listening to their needs, wants and fears, while also educating them about their recovery.

“A patient who has been heard, who feels respected, actively participates in their recovery,” Armstrong said. “The underlying important piece of empowerment is information.

“Show them what their rights are as an injured worker. Nurse case managers have a code of ethics: Advocate for the patient,” she said.

Giving an injured worker the tools to understand the claims process, supplying them with background on their particular type of injury and opening up every option available for recovery — even options not available through workers’ comp — empowers an injured worker to feel confident and actively participate in return to work.

“It doesn’t always come down to dollars and cents,” said Armstrong. “A positive outcome is good, because you have a positive employee who won’t seek legal action. You have a patient with no reason to seek outside resources who wants to get back to work.” &

Autumn Heisler is the digital producer and a staff writer at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

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Insurtech

Kiss Your Annual Renewal Goodbye; On-Demand Insurance Challenges the Traditional Policy

Gig workers' unique insurance needs drive delivery of on-demand coverage.
By: | September 14, 2018 • 6 min read

The gig economy is growing. Nearly six million Americans, or 3.8 percent of the U.S. workforce, now have “contingent” work arrangements, with a further 10.6 million in categories such as independent contractors, on-call workers or temporary help agency staff and for-contract firms, often with well-known names such as Uber, Lyft and Airbnb.

Scott Walchek, founding chairman and CEO, Trōv

The number of Americans owning a drone is also increasing — one recent survey suggested as much as one in 12 of the population — sparking vigorous debate on how regulation should apply to where and when the devices operate.

Add to this other 21st century societal changes, such as consumers’ appetite for other electronic gadgets and the advent of autonomous vehicles. It’s clear that the cover offered by the annually renewable traditional insurance policy is often not fit for purpose. Helped by the sophistication of insurance technology, the response has been an expanding range of ‘on-demand’ covers.

The term ‘on-demand’ is open to various interpretations. For Scott Walchek, founding chairman and CEO of pioneering on-demand insurance platform Trōv, it’s about “giving people agency over the items they own and enabling them to turn on insurance cover whenever they want for whatever they want — often for just a single item.”

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“On-demand represents a whole new behavior and attitude towards insurance, which for years has very much been a case of ‘get it and forget it,’ ” said Walchek.

Trōv’s mobile app enables users to insure just a single item, such as a laptop, whenever they wish and to also select the period of cover required. When ready to buy insurance, they then snap a picture of the sales receipt or product code of the item they want covered.

Welcoming Trōv: A New On-Demand Arrival

While Walchek, who set up Trōv in 2012, stressed it’s a technology company and not an insurance company, it has attracted industry giants such as AXA and Munich Re as partners. Trōv began the U.S. roll-out of its on-demand personal property products this summer by launching in Arizona, having already established itself in Australia and the United Kingdom.

“Australia and the UK were great testing grounds, thanks to their single regulatory authorities,” said Walchek. “Trōv is already approved in 45 states, and we expect to complete the process in all by November.

“On-demand products have a particular appeal to millennials who love the idea of having control via their smart devices and have embraced the concept of an unbundling of experiences: 75 percent of our users are in the 18 to 35 age group.” – Scott Walchek, founding chairman and CEO, Trōv

“On-demand products have a particular appeal to millennials who love the idea of having control via their smart devices and have embraced the concept of an unbundling of experiences: 75 percent of our users are in the 18 to 35 age group,” he added.

“But a mass of tectonic societal shifts is also impacting older generations — on-demand cover fits the new ways in which they work, particularly the ‘untethered’ who aren’t always in the same workplace or using the same device. So we see on-demand going into societal lifestyle changes.”

Wooing Baby Boomers

In addition to its backing for Trōv, across the Atlantic, AXA has partnered with Insurtech start-up By Miles, launching a pay-as-you-go car insurance policy in the UK. The product is promoted as low-cost car insurance for drivers who travel no more than 140 miles per week, or 7,000 miles annually.

“Due to the growing need for these products, companies such as Marmalade — cover for learner drivers — and Cuvva — cover for part-time drivers — have also increased in popularity, and we expect to see more enter the market in the near future,” said AXA UK’s head of telematics, Katy Simpson.

Simpson confirmed that the new products’ initial appeal is to younger motorists, who are more regular users of new technology, while older drivers are warier about sharing too much personal information. However, she expects this to change as on-demand products become more prevalent.

“Looking at mileage-based insurance, such as By Miles specifically, it’s actually older generations who are most likely to save money, as the use of their vehicles tends to decline. Our job is therefore to not only create more customer-centric products but also highlight their benefits to everyone.”

Another Insurtech ready to partner with long-established names is New York-based Slice Labs, which in the UK is working with Legal & General to enter the homeshare insurance market, recently announcing that XL Catlin will use its insurance cloud services platform to create the world’s first on-demand cyber insurance solution.

“For our cyber product, we were looking for a partner on the fintech side, which dovetailed perfectly with what Slice was trying to do,” said John Coletti, head of XL Catlin’s cyber insurance team.

“The premise of selling cyber insurance to small businesses needs a platform such as that provided by Slice — we can get to customers in a discrete, seamless manner, and the partnership offers potential to open up other products.”

Slice Labs’ CEO Tim Attia added: “You can roll up on-demand cover in many different areas, ranging from contract workers to vacation rentals.

“The next leap forward will be provided by the new economy, which will create a range of new risks for on-demand insurance to respond to. McKinsey forecasts that by 2025, ecosystems will account for 30 percent of global premium revenue.

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“When you’re a start-up, you can innovate and question long-held assumptions, but you don’t have the scale that an insurer can provide,” said Attia. “Our platform works well in getting new products out to the market and is scalable.”

Slice Labs is now reviewing the emerging markets, which aren’t hampered by “old, outdated infrastructures,” and plans to test the water via a hackathon in southeast Asia.

Collaboration Vs Competition

Insurtech-insurer collaborations suggest that the industry noted the banking sector’s experience, which names the tech disruptors before deciding partnerships, made greater sense commercially.

“It’s an interesting correlation,” said Slice’s managing director for marketing, Emily Kosick.

“I believe the trend worth calling out is that the window for insurers to innovate is much shorter, thanks to the banking sector’s efforts to offer omni-channel banking, incorporating mobile devices and, more recently, intelligent assistants like Alexa for personal banking.

“Banks have bought into the value of these technology partnerships but had the benefit of consumer expectations changing slowly with them. This compares to insurers who are in an ever-increasing on-demand world where the risk is high for laggards to be left behind.”

As with fintechs in banking, Insurtechs initially focused on the retail segment, with 75 percent of business in personal lines and the remainder in the commercial segment.

“Banks have bought into the value of these technology partnerships but had the benefit of consumer expectations changing slowly with them. This compares to insurers who are in an ever-increasing on-demand world where the risk is high for laggards to be left behind.” — Emily Kosick, managing director, marketing, Slice

Those proportions may be set to change, with innovations such as digital commercial insurance brokerage Embroker’s recent launch of the first digital D&O liability insurance policy, designed for venture capital-backed tech start-ups and reinsured by Munich Re.

Embroker said coverage that formerly took weeks to obtain is now available instantly.

“We focus on three main issues in developing new digital business — what is the customer’s pain point, what is the expense ratio and does it lend itself to algorithmic underwriting?” said CEO Matt Miller. “Workers’ compensation is another obvious class of insurance that can benefit from this approach.”

Jason Griswold, co-founder and chief operating officer of Insurtech REIN, highlighted further opportunities: “I’d add a third category to personal and business lines and that’s business-to-business-to-consumer. It’s there we see the biggest opportunities for partnering with major ecosystems generating large numbers of insureds and also big volumes of data.”

For now, insurers are accommodating Insurtech disruption. Will that change?

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“Insurtechs have focused on products that regulators can understand easily and for which there is clear existing legislation, with consumer protection and insurer solvency the two issues of paramount importance,” noted Shawn Hanson, litigation partner at law firm Akin Gump.

“In time, we could see the disruptors partner with reinsurers rather than primary carriers. Another possibility is the likes of Amazon, Alphabet, Facebook and Apple, with their massive balance sheets, deciding to link up with a reinsurer,” he said.

“You can imagine one of them finding a good Insurtech and buying it, much as Amazon’s purchase of Whole Foods gave it entry into the retail sector.” &

Graham Buck is a UK-based writer and has contributed to Risk & Insurance® since 1998. He can be reached at riskletters.com.