Legal Strategies

Lawyer Involved? Drive for Swift Resolution

Trust and communication can help keep legal costs from spiraling out of control.
By: | July 6, 2017 • 2 min read

Even after an injured worker “lawyers up” for a workers’ compensation claim, the best policy for all stakeholders — worker, employer, claims manager and carrier — is to press for a swift, equitable resolution while maintaining empathy and sound medical care, attorneys and claims managers agree.

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When attorneys get involved, said Edward E. Canavan, vice president, workers’ compensation practice and compliance, Sedgwick Claims Management Services, Inc., claims typically cost eight times more and lost time from work increases by three hundred percent.

Facing exponentially higher costs, the insurance community’s reflex “may be to dig in its heels,” said Canavan, but negotiation and compromise are usually more productive when dealing with attorneys, who are skilled in securing compensation.

“Focus on the resolution,” he advised. “Be assertive, manage the claim, pay all benefits due, but don’t be overly aggressive just because the case is litigated.”

By the time an applicant has lawyered up, said Bernie Baltaxe, partner, Smith & Baltaxe, LLP, who represents injured workers, the adversarial process has already begun simply by nature of litigation, “but the case has not necessarily gone south.”

Be assertive, manage the claim, pay all benefits due, but don’t be overly aggressive just because the case is litigated.— Edward E. Canavan, vice president, workers’ compensation practice and compliance, Sedgwick Claims Management Services, Inc.

Workers generally seek legal representation, Canavan said, because they haven’t given the carrier a chance to do the right thing, are fearful and anxious because they don’t know what to expect, or are angry, often about denial of treatment.

Most of his clients seek his representation, Baltaxe said, knowing that part of the claims adjustor’s role is to control costs. Fearing the execution of that role will come at their own expense, “they don’t trust the insurance company or claims adjustor 100 percent.” And sometimes trust decays because they simply can’t reach the claims adjustor on the phone.

Communicate, Communicate, Communicate

The best possible strategy for litigation, Canavan said, is to avoid it. Workers’ inclination to hire an attorney starts long before an injury. Disgruntled employees, and those who don’t understand workers’ compensation and return-to-work policies, are more likely to lawyer up.

Bernie Baltaxe, partner, Smith & Baltaxe, LLP

As a preemptive move, “employers can educate workers about workers comp to manage their expectations.” This may include information about what workers’ compensation covers and doesn’t cover in their jurisdiction, protocols for diagnostics and procedures and how to select doctors within workers’ comp medical networks.

The communication changes to an advocacy role after an injury. For the claims examiner and the employer, Canavan said, that means a constant stream of messages about recovery, education and empathy.

To manage the injured worker’s fears and anxiety, he said, the messages should start immediately and be tailored to the individual. “The claims manager should ask, ‘Is the injured worker demonstrating concern around returning to work? Is he worried about how to take care of himself and his family during his recovery?’”

Susannah Levine writes about health care, education and technology. She can be reached at [email protected]

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]