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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

2018 Risk All Stars

Stop Mitigating Risk. Start Conquering It Like These 2018 Risk All Stars

The concept of risk mastery and ownership, as displayed by the 2018 Risk All Stars, includes not simply seeking to control outcomes but taking full responsibility for them.
By: | September 14, 2018 • 3 min read

People talk a lot about how risk managers can get a seat at the table. The discussion implies that the risk manager is an outsider, striving to get the ear or the attention of an insider, the CEO or CFO.

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But there are risk managers who go about things in a different way. And the 2018 Risk All Stars are prime examples of that.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Goodyear’s Craig Melnick had only been with the global tire maker a few months when Hurricane Harvey dumped a record amount of rainfall on Houston.

Brilliant communication between Melnick and his new teammates gave him timely and valuable updates on the condition of manufacturing locations. Melnick remained in Akron, mastering the situation by moving inventory out of the storm’s path and making sure remediation crews were lined up ahead of time to give Goodyear its best leg up once the storm passed and the flood waters receded.

Goodyear’s resiliency in the face of the storm gave it credibility when it went to the insurance markets later that year for renewals. And here is where we hear a key phrase, produced by Kevin Garvey, one of Goodyear’s brokers at Aon.

“The markets always appreciate a risk manager who demonstrates ownership,” Garvey said, in what may be something of an understatement.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Dianne Howard, a 2018 Risk All Star and the director of benefits and risk management for the Palm Beach County School District, achieved ownership of $50 million in property storm exposures for the district.

With FEMA saying it wouldn’t pay again for district storm losses it had already paid for, Howard went to the London markets and was successful in getting coverage. She also hammered out a deal in London that would partially reimburse the district if it suffered a mass shooting and needed to demolish a building, like what happened at Sandy Hook in Connecticut.

2018 Risk All Star Jim Cunningham was well-versed enough to know what traditional risk management theories would say when hospitality workers were suffering too many kitchen cuts. “Put a cut-prevention plan in place,” is the traditional wisdom.

But Cunningham, the vice president of risk management for the gaming company Pinnacle Entertainment, wasn’t satisfied with what looked to him like a Band-Aid approach.

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Instead, he used predictive analytics, depending on his own team to assemble company-specific data, to determine which safety measures should be used company wide. The result? Claims frequency at the company dropped 60 percent in the first year of his program.

Alumine Bellone, a 2018 Risk All Star and the vice president of risk management for Ardent Health Services, faced an overwhelming task: Create a uniform risk management program when her hospital group grew from 14 hospitals in three states to 31 hospitals in seven.

Bellone owned the situation by visiting each facility right before the acquisition and again right after, to make sure each caregiving population was ready to integrate into a standardized risk management system.

After consolidating insurance policies, Bellone achieved $893,000 in synergies.

In each of these cases, and in more on the following pages, we see examples of risk managers who weren’t just knocking on the door; they were owning the room. &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, clarity of vision and passion.

See the complete list of 2018 Risk All Stars.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]