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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

More from Risk & Insurance

Cyber Resilience

No, Seriously. You Need a Comprehensive Cyber Incident Response Plan Before It’s Too Late.

Awareness of cyber risk is increasing, but some companies may be neglecting to prepare adequate response plans that could save them millions. 
By: | June 1, 2018 • 7 min read

To minimize the financial and reputational damage from a cyber attack, it is absolutely critical that businesses have a cyber incident response plan.

“Sadly, not all yet do,” said David Legassick, head of life sciences, tech and cyber, CNA Hardy.

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In the event of a breach, a company must be able to quickly identify and contain the problem, assess the level of impact, communicate internally and externally, recover where possible any lost data or functionality needed to resume business operations and act quickly to manage potential reputational risk.

This can only be achieved with help from the right external experts and the design and practice of a well-honed internal response.

The first step a company must take, said Legassick, is to understand its cyber exposures through asset identification, classification, risk assessment and protection measures, both technological and human.

According to Raf Sanchez, international breach response manager, Beazley, cyber-response plans should be flexible and applicable to a wide range of incidents, “not just a list of consecutive steps.”

They also should bring together key stakeholders and specify end goals.

Jason J. Hogg, CEO, Aon Cyber Solutions

With bad actors becoming increasingly sophisticated and often acting in groups, attack vectors can hit companies from multiple angles simultaneously, meaning a holistic approach is essential, agreed Jason J. Hogg, CEO, Aon Cyber Solutions.

“Collaboration is key — you have to take silos down and work in a cross-functional manner.”

This means assembling a response team including individuals from IT, legal, operations, risk management, HR, finance and the board — each of whom must be well drilled in their responsibilities in the event of a breach.

“You can’t pick your players on the day of the game,” said Hogg. “Response times are critical, so speed and timing are of the essence. You should also have a very clear communication plan to keep the CEO and board of directors informed of recommended courses of action and timing expectations.”

People on the incident response team must have sufficient technical skills and access to critical third parties to be able to make decisions and move to contain incidents fast. Knowledge of the company’s data and network topology is also key, said Legassick.

“Perhaps most important of all,” he added, “is to capture in detail how, when, where and why an incident occurred so there is a feedback loop that ensures each threat makes the cyber defense stronger.”

Cyber insurance can play a key role by providing a range of experts such as forensic analysts to help manage a cyber breach quickly and effectively (as well as PR and legal help). However, the learning process should begin before a breach occurs.

Practice Makes Perfect

“Any incident response plan is only as strong as the practice that goes into it,” explained Mike Peters, vice president, IT, RIMS — who also conducts stress testing through his firm Sentinel Cyber Defense Advisors.

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Unless companies have an ethical hacker or certified information security officer on board who can conduct sophisticated simulated attacks, Peters recommended they hire third-party experts to test their networks for weaknesses, remediate these issues and retest again for vulnerabilities that haven’t been patched or have newly appeared.

“You need to plan for every type of threat that’s out there,” he added.

Hogg agreed that bringing third parties in to conduct tests brings “fresh thinking, best practice and cross-pollination of learnings from testing plans across a multitude of industries and enterprises.”

“Collaboration is key — you have to take silos down and work in a cross-functional manner.” — Jason J. Hogg, CEO, Aon Cyber Solutions

Legassick added that companies should test their plans at least annually, updating procedures whenever there is a significant change in business activity, technology or location.

“As companies expand, cyber security is not always front of mind, but new operations and territories all expose a company to new risks.”

For smaller companies that might not have the resources or the expertise to develop an internal cyber response plan from whole cloth, some carriers offer their own cyber risk resources online.

Evan Fenaroli, an underwriting product manager with the Philadelphia Insurance Companies (PHLY), said his company hosts an eRiskHub, which gives PHLY clients a place to start looking for cyber event response answers.

That includes access to a pool of attorneys who can guide company executives in creating a plan.

“It’s something at the highest level that needs to be a priority,” Fenaroli said. For those just getting started, Fenaroli provided a checklist for consideration:

  • Purchase cyber insurance, read the policy and understand its notice requirements.
  • Work with an attorney to develop a cyber event response plan that you can customize to your business.
  • Identify stakeholders within the company who will own the plan and its execution.
  • Find outside forensics experts that the company can call in an emergency.
  • Identify a public relations expert who can be called in the case of an event that could be leaked to the press or otherwise become newsworthy.

“When all of these things fall into place, the outcome is far better in that there isn’t a panic,” said Fenaroli, who, like others, recommends the plan be tested at least annually.

Cyber’s Physical Threat

With the digital and physical worlds converging due to the rise of the Internet of Things, Hogg reminded companies: “You can’t just test in the virtual world — testing physical end-point security is critical too.”

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How that testing is communicated to underwriters should also be a key focus, said Rich DePiero, head of cyber, North America, Swiss Re Corporate Solutions.

Don’t just report on what went well; it’s far more believable for an underwriter to hear what didn’t go well, he said.

“If I hear a client say it is perfect and then I look at some of the results of the responses to breaches last year, there is a disconnect. Help us understand what you learned and what you worked out. You want things to fail during these incident response tests, because that is how we learn,” he explained.

“Bringing in these outside firms, detailing what they learned and defining roles and responsibilities in the event of an incident is really the best practice, and we are seeing more and more companies do that.”

Support from the Board

Good cyber protection is built around a combination of process, technology, learning and people. While not every cyber incident needs to be reported to the boardroom, senior management has a key role in creating a culture of planning and risk awareness.

David Legassick, head of life sciences, tech and cyber, CNA Hardy

“Cyber is a boardroom risk. If it is not taken seriously at boardroom level, you are more than likely to suffer a network breach,” Legassick said.

However, getting board buy-in or buy-in from the C-suite is not always easy.

“C-suite executives often put off testing crisis plans as they get in the way of the day job. The irony here is obvious given how disruptive an incident can be,” said Sanchez.

“The C-suite must demonstrate its support for incident response planning and that it expects staff at all levels of the organization to play their part in recovering from serious incidents.”

“What these people need from the board is support,” said Jill Salmon, New York-based vice president, head of cyber/tech/MPL, Berkshire Hathaway Specialty Insurance.

“I don’t know that the information security folks are looking for direction from the board as much as they are looking for support from a resources standpoint and a visibility standpoint.

“They’ve got to be aware of what they need and they need to have the money to be able to build it up to that level,” she said.

Without that support, according to Legassick, failure to empower and encourage the IT team to manage cyber threats holistically through integration with the rest of the organization, particularly risk managers, becomes a common mistake.

He also warned that “blame culture” can prevent staff from escalating problems to management in a timely manner.

Collaboration and Communication

Given that cyber incident response truly is a team effort, it is therefore essential that a culture of collaboration, preparation and practice is embedded from the top down.

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One of the biggest tripping points for companies — and an area that has done the most damage from a reputational perspective — is in how quickly and effectively the company communicates to the public in the aftermath of a cyber event.

Salmon said of all the cyber incident response plans she has seen, the companies that have impressed her most are those that have written mock press releases and rehearsed how they are going to respond to the media in the aftermath of an event.

“We have seen so many companies trip up in that regard,” she said. “There have been examples of companies taking too long and then not explaining why it took them so long. It’s like any other crisis — the way that you are communicating it to the public is really important.” &

Antony Ireland is a London-based financial journalist. He can be reached at [email protected] Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]