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

More from Risk & Insurance

High Net Worth

High Net Worth Clients Live in CAT Zones. Here’s What Their Resiliency Plan Should Include

Having a resiliency plan and practicing it can make all the difference in a disaster.
By: | September 14, 2018 • 7 min read

Packed with state-of-the-art electronics, priceless collections and high-end furnishings, and situated in scenic, often remote locations, the dwellings of high net worth individuals and families pose particular challenges when it comes to disaster resiliency. But help is on the way.

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Armed with loss data, innovative new programs, technological advances, and a growing army of niche service-providers aimed at addressing an astonishingly diverse set of risks, insurers are increasingly determined to not just insure against their high net worth clients’ losses, but to prevent them.

Insurers have long been proactive in risk mitigation, but increasingly, after the recent surge in wildfire and storm losses, insureds are now, too.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy,” said Laura Sherman, founding partner at Baldwin Krystyn Sherman Partners.

And especially in the high net worth space, preventing that loss is vastly preferable to a payout, for insurers and insureds alike.

“If insurers can preserve even one house that’s 10 or 20 or 40 million dollars … whatever they have spent in a year is money well spent. Plus they’ve saved this important asset for the client,” said Bruce Gendelman, chairman and founder Bruce Gendelman Insurance Services.

High Net Worth Vulnerabilities

Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

As the number and size of luxury homes built in vulnerable areas has increased, so has the frequency and magnitude of extreme weather events, including hurricanes, harsh cold and winter storms, and wildfires.

“There is a growing desire to inhabit this riskier terrain,” said Jason Metzger, SVP Risk Management, PURE group of insurance companies. “In the western states alone, a little over a million homes are highly vulnerable to wildfires because of their proximity to forests that are fuller of fuel than they have been in years past.”

Such homes are often filled with expensive artwork and collections, from fine wine to rare books to couture to automobiles, each presenting unique challenges. The homes themselves present other vulnerabilities.

“Larger, more sophisticated homes are bristling with more technology than ever,” said Stephen Poux, SVP and head of Risk Management Services and Loss Prevention for AIG’s Private Client Group.

“A lightning strike can trash every electronic in the home.”

Niche Service Providers

A variety of niche service providers are stepping forward to help.

Secure facilities provide hurricane-proof, wildfire-proof off-site storage for artwork, antiques, and all manner of collectibles for seasonal or rotating storage, as well as ahead of impending disasters.

Other companies help manage such collections — a substantial challenge anytime, but especially during a crisis.

“Knowing where it is, is a huge part of mitigating the risk,” said Eric Kahan, founder of Collector Systems, a cloud-based collection management company that allows collectors to monitor their collections during loans to museums, transit between homes, or evacuation to secure storage.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy.” — Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

Insurers also employ specialists in-house. AIG employs four art curators who advise clients on how to protect and preserve their art collections.

Perhaps the best known and most striking example of this kind of direct insurer involvement are the fire teams insurers retain or employ to monitor fires and even spray retardant or water on threatened properties.

High-Level Service for High Net Worth

All high net worth carriers have programs that leverage expertise, loss data, and relationships with vendors to help clients avoid and recover from losses, employing the highest levels of customer service to accomplish this as unobtrusively as possible.

“What allows you to do your job best is when you develop that relationship with a client, where it’s the same people that are interacting with them on every front for their risk management,” said Steve Bitterman, chief risk services officer for Vault Insurance.

Site visits are an essential first step, allowing insurers to assess risks, make recommendations to reduce them, and establish plans in the event of a disaster.

“When you’re in a catastrophic situation, it’s high stress, time is of the essence, and people forget things,” said Sherman. “Having a written plan in place is paramount to success.”

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Another important component is knowing who will execute that plan in homes that are often unoccupied.

Domestic staff may lack the knowledge or authority to protect the homeowner’s assets, and during a disaster may be distracted dealing with threats to their own homes and families. Adequate planning includes ensuring that whoever is responsible has the training and authority to execute the plan.

Evaluating New Technology

Insurers use technologies like GPS and satellite imagery to determine which homes are directly threatened by storms or wildfires. They also assess and vet technologies that can be implemented by homeowners, from impact glass to alarm and monitoring systems, to more obscure but potentially more important options.

AIG’s Poux recommends two types of vents that mitigate important, and unexpected risks.

“There’s a fantastic technology called Smart Vent, which allows water to flow in and out of the foundation,” Poux said. “… The weight of water outside a foundation can push a foundation wall in. If you equalize that water inside and out at the same level, you negate that.”

Another wildfire risk — embers getting sucked into the attic — is, according to Poux, “typically the greatest cause of the destruction of homes.” But, he said, “Special ember-resisting venting, like Brandguard Vents, can remove that exposure altogether.”

Building Smart

Many disaster resiliency technologies can be applied at any time, but often the cost is fractional if implemented during initial construction. AIG’s Smart Build is a free program for new or remodeled homes that evolved out of AIG’s construction insurance programs.

Previously available only to homes valued at $5 million and up, Smart Build recently expanded to include homes of $1 million and up. Roughly 100 homes are enrolled, with an average value of $13 million.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work.” — Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“We know what goes wrong in high net worth homes,” said Poux, citing AIG’s decades of loss data.

“We’re incenting our client and by proxy their builder, their architects and their broker, to give us a seat at the design table. … That enables us to help tweak the architectural plans in ways that are very easy to do with a pencil, as opposed to after a home is built.”

Poux cites a remote ranch property in Texas.

Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“The client was rebuilding a home but also installing new roads and grading and driveways. … The property was very far from the fire department and there wasn’t any available water on the property.”

Poux’s team was able to recommend underground water storage tanks, something that would have been prohibitively expensive after construction.

“But if the ground is open and you’ve got heavy equipment, it’s a relatively minor additional expense.”

Homes that graduate from the Smart Build program may be eligible for preferred pricing due to their added resilience, Poux said.

Recovery from Loss

A major component of disaster resiliency is still recovery from loss, and preparation is key to the prompt service expected by homeowners paying six- or seven-figure premiums.

Before Irma, PURE sent contact information for pre-assigned claim adjusters to insureds in the storm’s direct path.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work,” said Curt Goetsch, head of underwriting for Ironshore’s Private Client Group.

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“If you’ve got custom construction or imported materials in your house, you’re not going to go down the street and just find somebody that can do that kind of work, or has those materials in stock.”

In the wake of disaster, even basic services can be scarce.

“Our claims and risk management departments have to work together in advance of the storm,” said Bitterman, “to have contractors and restoration companies and tarp and board services that are going to respond to our company’s clients, that will commit resources to us.”

And while local agents’ connections can be invaluable, Goetsch sees insurers taking more of that responsibility from the agent, to at least get the claim started.

“When there is a disaster, the agency’s staff may have to deal with personal losses,” Goetsch said. &

Jon McGoran is a novelist and magazine editor based outside of Philadelphia. He can be reached at [email protected]