Nurse Case Manager Chronicles

The Injured Worker’s Family

Incidents at work affect more than the injured. How can a nurse case manager help the family cope?
By: | January 10, 2018 • 4 min read

Wendy Woodard knows what it takes to get a catastrophic case moving. In just six months, this nurse case manager for Ascential Care got an injured patient back on his feet and cleared for work without restrictions.


But the road leading to recovery wasn’t always smooth; like in many claims cases, Woodard had her fair share of obstacles to overcome.

“Nurses work with the patient’s family emotionally so they can get the patient where they need to be,” she said. “This [particular patient’s] family did not work in the medical field. They were worried about him being placed so far away with no one around him.”

The patient, a pharmacist by profession, was driving when a tree fell on his vehicle, cracking the roof of the car — and his skull.

He suffered a traumatic brain injury, a spinal fracture, pulmonary contusions and facial fractures, among other ailments. Woodard went to the hospital two days after the patient was admitted to the ICU.

His condition was critical.

“I didn’t know the extent of his injuries until I got there,” she said. “The hospital was still trying to stabilize the patient.”

Immediately, Woodard began coordinating the best care option for the patient. They lived in an area with a level one trauma center but not a rehabilitation center for traumatic brain injuries. The nurse knew the patient’s best chance at recovery would be at Shepherd Center, a spinal cord and brain injury rehabilitation center in Atlanta, Georgia — five and a half hours away.

Wendy Woodard, nurse case manager, Ascential Care

The family was hesitant.

“The patient was in his late fifties. He had four children, a brother and his ex-wife waiting for him. There was a lot of back and forth on who would manage his care,” Woodard explained.

The patient’s oldest daughter and his brother both wanted to be the go-to person for decisions, but they found the long trip to Shepherd daunting. They didn’t want their loved one so far away during a critical and demanding time in his life.

Woodard, a nurse case manager for 18 years, knew what to do: She talked to the family.

“We talked about not having the right rehab facility. If he was going to make a full recovery, we had to get him where he needed to be,” she said. “My role was to provide them with knowledge on brain injuries and get the right care to the patient.”

She brought in pamphlets, pulled up Internet searches on the patient’s injuries, explained each type of fracture to the family and answered questions. But Woodard didn’t stop with facts; she entered the hospital every day for three weeks, checking in on the family’s emotional state.

“I was there, every day, offering emotional support,” she said. “The patient’s daughter cried on my shoulder. We went over and over what his best options were.”

In the end, the family agreed to send him to Shepherd.

Recuperation and Recovery

Once the patient was stabilized — a process that took three weeks — he was moved to the rehab facility.

When he started to respond, Woodard said the team assessed any permanent damage. The injury left the patient with permanent left-side facial paralysis and cranial nerve deficits. He had lost hearing in his left ear, was dizzy, disoriented and discouraged.

“He wouldn’t speak, was withdrawn and depressed,” said Woodard. The team worried about the patient’s cognitive function. As a pharmacist, the man needed to gain back his cognitive abilities if he wanted to work in the field again. Woodard noted he was a very intelligent man, and, after three weeks, he started to understand.

“It’s remarkable how well he did. He was very determined.”


Slowly but surely, the patient regained his speech and other cognitive functions back, and he transferred to a half-way house. Woodard coordinated with the physical therapist and the occupational therapist, setting up appointments and monitoring progress. She worked with the claims adjuster to guarantee the patient’s schedule for checkups with his neurologist.

By the time the patient returned home, the nurse had his appointments set, eliminating delays in care.

“My goal is always to get my patient back to work and back to a normal life, because that’s the best thing for them,” Woodard said.

Six months after the injury, doctors cleared the pharmacist for a return to work with no restrictions.

“I do not think he would have gained his cognitive skills if the family hadn’t agreed to move him,” she said. “The educational role nurses play is so important to the family.” &

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Focus: Cyber

Expanding Cyber BI

Cyber business interruption insurance is a thriving market, but growth carries the threat of a mega-loss. 
By: | March 5, 2018 • 7 min read

Lingering hopes that large-scale cyber attack might be a once-in-a-lifetime event were dashed last year. The four-day WannaCry ransomware strike in May across 150 countries targeted more than 300,000 computers running Microsoft Windows. A month later, NotPetya hit multinationals ranging from Danish shipping firm Maersk to pharmaceutical giant Merck.


Maersk’s chairman, Jim Hagemann Snabe, revealed at this year’s Davos summit that NotPetya shut down most of the group’s network. While it was replacing 45,000 PCs and 4,000 servers, freight transactions had to be completed manually. The combined cost of business interruption and rebuilding the system was up to $300 million.

Merck’s CFO Robert Davis told investors that its NotPetya bill included $135 million in lost sales plus $175 million in additional costs. Fellow victims FedEx and French construction group Saint Gobain reported similar financial hits from lost business and clean-up costs.

The fast-expanding world of cryptocurrencies is also increasingly targeted. Echoes of the 2014 hack that triggered the collapse of Bitcoin exchange Mt. Gox emerged this January when Japanese cryptocurrency exchange Coincheck pledged to repay customers $500 million stolen by hackers in a cyber heist.

The size and scope of last summer’s attacks accelerated discussions on both sides of the Atlantic, between risk managers and brokers seeking more comprehensive cyber business interruption insurance products.

It also recently persuaded Pool Re, the UK’s terrorism reinsurance pool set up 25 years ago after bomb attacks in London’s financial quarter, to announce that from April its cover will extend to include material damage and direct BI resulting from acts of terrorism using a cyber trigger.

“The threat from a cyber attack is evident, and businesses have become increasingly concerned about the extensive repercussions these types of attacks could have on them,” said Pool Re’s chief, Julian Enoizi. “This was a clear gap in our coverage which left businesses potentially exposed.”

Shifting Focus

Development of cyber BI insurance to date reveals something of a transatlantic divide, said Hans Allnutt, head of cyber and data risk at international law firm DAC Beachcroft. The first U.S. mainstream cyber insurance products were a response to California’s data security and breach notification legislation in 2003.

Jimaan Sané, technology underwriter, Beazley

Of more recent vintage, Europe’s first cyber policies’ wordings initially reflected U.S. wordings, with the focus on data breaches. “So underwriters had to innovate and push hard on other areas of cyber cover, particularly BI and cyber crimes such as ransomware demands and distributed denial of service attacks,” said Allnut.

“Europe now has regulation coming up this May in the form of the General Data Protection Regulation across the EU, so the focus has essentially come full circle.”

Cyber insurance policies also provide a degree of cover for BI resulting from one of three main triggers, said Jimaan Sané, technology underwriter for specialist insurer Beazley. “First is the malicious-type trigger, where the system goes down or an outage results directly from a hack.

“Second is any incident involving negligence — the so-called ‘fat finger’ — where human or operational error causes a loss or there has been failure to upgrade or maintain the system. Third is any broader unplanned outage that hits either the company or anyone on which it relies, such as a service provider.”

The importance of cyber BI covering negligent acts in addition to phishing and social engineering attacks was underlined by last May’s IT meltdown suffered by airline BA.

This was triggered by a technician who switched off and then reconnected the power supply to BA’s data center, physically damaging servers and distribution panels.

Compensating delayed passengers cost the company around $80 million, although the bill fell short of the $461 million operational error loss suffered by Knight Capital in 2012, which pushed it close to bankruptcy and decimated its share price.

Mistaken Assumption

Awareness of potentially huge BI losses resulting from cyber attack was heightened by well-publicized hacks suffered by retailers such as Target and Home Depot in late 2013 and 2014, said Matt Kletzli, SVP and head of management liability at Victor O. Schinnerer & Company.


However, the incidents didn’t initially alarm smaller, less high-profile businesses, which assumed they wouldn’t be similarly targeted.

“But perpetrators employing bots and ransomware set out to expose any firms with weaknesses in their system,” he added.

“Suddenly, smaller firms found that even when they weren’t themselves targeted, many of those around them had fallen victim to attacks. Awareness started to lift, as the focus moved from large, headline-grabbing attacks to more everyday incidents.”

Publications such as the Director’s Handbook of Cyber-Risk Oversight, issued by the National Association of Corporate Directors and the Internet Security Alliance fixed the issue firmly on boardroom agendas.

“What’s possibly of greater concern is the sheer number of different businesses that can be affected by a single cyber attack and the cost of getting them up and running again quickly.” — Jimaan Sané, technology underwriter, Beazley

Reformed ex-hackers were recruited to offer board members their insights into the most vulnerable points across the company’s systems — in much the same way as forger-turned-security-expert Frank Abagnale Jr., subject of the Spielberg biopic “Catch Me If You Can.”

There also has been an increasing focus on systemic risk related to cyber attacks. Allnutt cites “Business Blackout,” a July 2015 study by Lloyd’s of London and the Cambridge University’s Centre for Risk Studies.

This detailed analysis of what could result from a major cyber attack on America’s power grid predicted a cost to the U.S. economy of hundreds of billions and claims to the insurance industry totalling upwards of $21.4 billion.

Lloyd’s described the scenario as both “technologically possible” and “improbable.” Three years on, however, it appears less fanciful.

In January, the head of the UK’s National Cyber Security Centre, Ciaran Martin, said the UK had been fortunate in so far averting a ‘category one’ attack. A C1 would shut down the financial services sector on which the country relies heavily and other vital infrastructure. It was a case of “when, not if” such an assault would be launched, he warned.

AI: Friend or Foe?

Despite daunting potential financial losses, pioneers of cyber BI insurance such as Beazley, Zurich, AIG and Chubb now see new competitors in the market. Capacity is growing steadily, said Allnutt.

“Not only is cyber insurance a new product, it also offers a new source of premium revenue so there is considerable appetite for taking it on,” he added. “However, whilst most insurers are comfortable with the liability aspects of cyber risk; not all insurers are covering loss of income.”

Matt Kletzli, SVP and head of management liability, Victor O. Schinnerer & Company

Kletzli added that available products include several well-written, broad cyber coverages that take into account all types of potential cyber attack and don’t attempt to limit cover by applying a narrow definition of BI loss.

“It’s a rapidly-evolving coverage — and needs to be — in order to keep up with changing circumstances,” he said.

The good news, according to a Fitch report, is that the cyber loss ratio has been reduced to 45 percent as more companies buy cover and the market continues to expand, bringing down the size of the average loss.

“The bad news is that at cyber events, talk is regularly turning to ‘what will be the Hurricane Katrina-type event’ for the cyber market?” said Kletzli.

“What’s worse is that with hurricane losses, underwriters know which regions are most at risk, whereas cyber is a global risk and insurers potentially face huge aggregation.”


Nor is the advent of robotics and artificial intelligence (AI) necessarily cause for optimism. As Allnutt noted, while AI can potentially be used to decode malware, by the same token sophisticated criminals can employ it to develop new malware and escalate the ‘computer versus computer’ battle.

“The trend towards greater automation of business means that we can expect more incidents involving loss of income,” said Sané. “What’s possibly of greater concern is the sheer number of different businesses that can be affected by a single cyber attack and the cost of getting them up and running again quickly.

“We’re likely to see a growing number of attacks where the aim is to cause disruption, rather than demand a ransom.

“The paradox of cyber BI is that the more sophisticated your organization and the more it embraces automation, the bigger the potential impact when an outage does occur. Those old-fashioned businesses still reliant on traditional processes generally aren’t affected as much and incur smaller losses.” &

Graham Buck is editor of He can be reached at