Nurse Case Manager Chronicles

The Power of a Job Description: Cut Claim Time and Prevent Reinjury

With a detailed and accurate job description at the ready, case managers can help treating physicians make better decisions about return-to-work options.
By: | May 25, 2018 • 5 min read

Even when you’re doing everything possible for an injured worker, a successful return-to-work transition can be jeopardized when a treating physician isn’t attuned to the ins and outs of the worker’s job.

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“It’s helpful for physicians to know the demands for a position,” said Trish Elizalde, a branch manager for Genex Services. Elizalde served as a case manager for 10 years.

“A job description helps a doctor visualize what the worker does on the job and it helps physicians facilitate return-to-work decisions that help get injured workers back to the jobsite while keeping them safe from reinjury.”

Playing an integral role in the healing process, physicians assess injured workers’ impairment, create treatment plans and administer care where needed. They also provide employers and other third parties with updated information on the worker’s progress.

If they lack the knowledge and understanding of a particular job, they could keep a worker at home unnecessarily, delaying the healing process. Worse, they might send a worker back to the grind too soon — the perfect recipe for a second serious injury and prolonged recovery.

It’s in the Details

It may seem like a small piece to the overall claims puzzle, but “job descriptions are huge,” said Elizalde.

By knowing what an injured worker does day-in and day-out, from lifting requirements to frequency of tasks, a physician is better suited to set restrictions while introducing an injured worker back to their job.

Trish Elizalde, branch manager, Genex Services

“An accurate job description assists the treating physician in making decisions about whether an injured worker is able to return to work in any capacity,” she said. “They welcome this information.”

A seasoned case manager, Elizalde said that nurse case managers (NCMs) gather this vital information from employers before conducting site evaluations, breaking down the physical aspects of a worker’s job.

“We strive to obtain a job description on every case. [Case managers] know the right questions to ask and what the physicians are looking for in terms of the physical demands of a position.”

Through this information, the hope is to gain enough insight to maximize and speed recovery. A thorough job description answers how much weight is lifted, how often and for how long. Do employees lift objects from the floor? Is it to waist height or overhead? How far does an employee carry an object, and do they use the assistance of a lifting device?

In addition to lifting, the form documents how long an employee sits or stands, if they bend or squat, or climb stairs or ladders.

“Most of our case managers have safety hats and boots in their car. They’re prepared for anything.” — Trish Elizalde, branch manager, Genex Services

“Some activities might be observed once while others might be observed over a longer period of time,” Elizalde said. “We estimate what percentage of their workday is engaged in a particular activity. We note if they worked with machinery, hand-held tools, operated motor vehicles or if they were indoors or outdoors in varying temperatures.

“The extent of the details we gather is to provide the best physical description of the job to ensure the injured worker’s safe return to work and to avoid further injury or exacerbate the current injury.”

Sometimes, however, the employer is hesitant to provide information.

“Employers want to know why we’re doing this,” she said. “Their biggest concerns are security and safety issues.”

Time constraint is the most common reason why an employer may not have a job description handy for a case manager, said Elizalde. And she understands why: “Employers are very busy, but we are finding that employers are becoming more engaged, and we appreciate that.”

There are also employers, she said, who understand the importance of an accurate job description and the value that it adds to a workers’ compensation program. These employers have “invested time to establish a bank or database of job descriptions,” over time.

Elizalde added, “Our case managers certainly try to provide information to employers about how job descriptions are used by physicians to make return-to-work decisions. If we feel the job description is incomplete or if there are questions regarding an aspect of the position, we contact the employer to ask additional questions or suggest an onsite visit.”

During a site visit, NCMs conduct an evaluation of an injured worker’s job requirements. They may speak with others doing similar tasks to see what the injured employee might be doing upon returning to work. Elizalde called this the “parts of the job not talked about” — that is,

 minúte details of a position that aren’t included in a broad job description.

However, said Elizalde, having a case manager enter an active construction site or power plant — where there is high risk of injury due to heavy machinery — can set employers on edge, with safety becoming a concern once again.

But getting in and getting that job description is vital to the process.

“Most of our case managers have safety hats and boots in their car. They’re prepared for anything,” she said.

Return to Work

Through the job description, physicians can learn the aspects of a job. Workers are often asked to review job descriptions submitted to their physicians as well, guaranteeing accuracy.

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In addition to getting feedback from the injured worker, NCMs make sure they are communicating with the employer during the road to recovery. Case managers work with the physician and employer to find temporary or partial duty tasks that injured workers can perform until they are ready to return fully recovered.

“We want to get the [injured worker] out of their house, get them moving, get them back to normal.” Elizalde said. “Some employers don’t even know that they can bring back a worker on modified duty.”

Much like the information NCMs provide to an adjuster, she said, case managers will update the employer on their worker’s status to keep them engaged in the claims process.

“We find that when an employer is engaged in the comp process, employees have better results. We’re happy to lend our expertise to assist employers in creating a job description when one is not available, as well.” &

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

Insurtech

Kiss Your Annual Renewal Goodbye; On-Demand Insurance Challenges the Traditional Policy

Gig workers' unique insurance needs drive delivery of on-demand coverage.
By: | September 14, 2018 • 6 min read

The gig economy is growing. Nearly six million Americans, or 3.8 percent of the U.S. workforce, now have “contingent” work arrangements, with a further 10.6 million in categories such as independent contractors, on-call workers or temporary help agency staff and for-contract firms, often with well-known names such as Uber, Lyft and Airbnb.

Scott Walchek, founding chairman and CEO, Trōv

The number of Americans owning a drone is also increasing — one recent survey suggested as much as one in 12 of the population — sparking vigorous debate on how regulation should apply to where and when the devices operate.

Add to this other 21st century societal changes, such as consumers’ appetite for other electronic gadgets and the advent of autonomous vehicles. It’s clear that the cover offered by the annually renewable traditional insurance policy is often not fit for purpose. Helped by the sophistication of insurance technology, the response has been an expanding range of ‘on-demand’ covers.

The term ‘on-demand’ is open to various interpretations. For Scott Walchek, founding chairman and CEO of pioneering on-demand insurance platform Trōv, it’s about “giving people agency over the items they own and enabling them to turn on insurance cover whenever they want for whatever they want — often for just a single item.”

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“On-demand represents a whole new behavior and attitude towards insurance, which for years has very much been a case of ‘get it and forget it,’ ” said Walchek.

Trōv’s mobile app enables users to insure just a single item, such as a laptop, whenever they wish and to also select the period of cover required. When ready to buy insurance, they then snap a picture of the sales receipt or product code of the item they want covered.

Welcoming Trōv: A New On-Demand Arrival

While Walchek, who set up Trōv in 2012, stressed it’s a technology company and not an insurance company, it has attracted industry giants such as AXA and Munich Re as partners. Trōv began the U.S. roll-out of its on-demand personal property products this summer by launching in Arizona, having already established itself in Australia and the United Kingdom.

“Australia and the UK were great testing grounds, thanks to their single regulatory authorities,” said Walchek. “Trōv is already approved in 45 states, and we expect to complete the process in all by November.

“On-demand products have a particular appeal to millennials who love the idea of having control via their smart devices and have embraced the concept of an unbundling of experiences: 75 percent of our users are in the 18 to 35 age group.” – Scott Walchek, founding chairman and CEO, Trōv

“On-demand products have a particular appeal to millennials who love the idea of having control via their smart devices and have embraced the concept of an unbundling of experiences: 75 percent of our users are in the 18 to 35 age group,” he added.

“But a mass of tectonic societal shifts is also impacting older generations — on-demand cover fits the new ways in which they work, particularly the ‘untethered’ who aren’t always in the same workplace or using the same device. So we see on-demand going into societal lifestyle changes.”

Wooing Baby Boomers

In addition to its backing for Trōv, across the Atlantic, AXA has partnered with Insurtech start-up By Miles, launching a pay-as-you-go car insurance policy in the UK. The product is promoted as low-cost car insurance for drivers who travel no more than 140 miles per week, or 7,000 miles annually.

“Due to the growing need for these products, companies such as Marmalade — cover for learner drivers — and Cuvva — cover for part-time drivers — have also increased in popularity, and we expect to see more enter the market in the near future,” said AXA UK’s head of telematics, Katy Simpson.

Simpson confirmed that the new products’ initial appeal is to younger motorists, who are more regular users of new technology, while older drivers are warier about sharing too much personal information. However, she expects this to change as on-demand products become more prevalent.

“Looking at mileage-based insurance, such as By Miles specifically, it’s actually older generations who are most likely to save money, as the use of their vehicles tends to decline. Our job is therefore to not only create more customer-centric products but also highlight their benefits to everyone.”

Another Insurtech ready to partner with long-established names is New York-based Slice Labs, which in the UK is working with Legal & General to enter the homeshare insurance market, recently announcing that XL Catlin will use its insurance cloud services platform to create the world’s first on-demand cyber insurance solution.

“For our cyber product, we were looking for a partner on the fintech side, which dovetailed perfectly with what Slice was trying to do,” said John Coletti, head of XL Catlin’s cyber insurance team.

“The premise of selling cyber insurance to small businesses needs a platform such as that provided by Slice — we can get to customers in a discrete, seamless manner, and the partnership offers potential to open up other products.”

Slice Labs’ CEO Tim Attia added: “You can roll up on-demand cover in many different areas, ranging from contract workers to vacation rentals.

“The next leap forward will be provided by the new economy, which will create a range of new risks for on-demand insurance to respond to. McKinsey forecasts that by 2025, ecosystems will account for 30 percent of global premium revenue.

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“When you’re a start-up, you can innovate and question long-held assumptions, but you don’t have the scale that an insurer can provide,” said Attia. “Our platform works well in getting new products out to the market and is scalable.”

Slice Labs is now reviewing the emerging markets, which aren’t hampered by “old, outdated infrastructures,” and plans to test the water via a hackathon in southeast Asia.

Collaboration Vs Competition

Insurtech-insurer collaborations suggest that the industry noted the banking sector’s experience, which names the tech disruptors before deciding partnerships, made greater sense commercially.

“It’s an interesting correlation,” said Slice’s managing director for marketing, Emily Kosick.

“I believe the trend worth calling out is that the window for insurers to innovate is much shorter, thanks to the banking sector’s efforts to offer omni-channel banking, incorporating mobile devices and, more recently, intelligent assistants like Alexa for personal banking.

“Banks have bought into the value of these technology partnerships but had the benefit of consumer expectations changing slowly with them. This compares to insurers who are in an ever-increasing on-demand world where the risk is high for laggards to be left behind.”

As with fintechs in banking, Insurtechs initially focused on the retail segment, with 75 percent of business in personal lines and the remainder in the commercial segment.

“Banks have bought into the value of these technology partnerships but had the benefit of consumer expectations changing slowly with them. This compares to insurers who are in an ever-increasing on-demand world where the risk is high for laggards to be left behind.” — Emily Kosick, managing director, marketing, Slice

Those proportions may be set to change, with innovations such as digital commercial insurance brokerage Embroker’s recent launch of the first digital D&O liability insurance policy, designed for venture capital-backed tech start-ups and reinsured by Munich Re.

Embroker said coverage that formerly took weeks to obtain is now available instantly.

“We focus on three main issues in developing new digital business — what is the customer’s pain point, what is the expense ratio and does it lend itself to algorithmic underwriting?” said CEO Matt Miller. “Workers’ compensation is another obvious class of insurance that can benefit from this approach.”

Jason Griswold, co-founder and chief operating officer of Insurtech REIN, highlighted further opportunities: “I’d add a third category to personal and business lines and that’s business-to-business-to-consumer. It’s there we see the biggest opportunities for partnering with major ecosystems generating large numbers of insureds and also big volumes of data.”

For now, insurers are accommodating Insurtech disruption. Will that change?

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“Insurtechs have focused on products that regulators can understand easily and for which there is clear existing legislation, with consumer protection and insurer solvency the two issues of paramount importance,” noted Shawn Hanson, litigation partner at law firm Akin Gump.

“In time, we could see the disruptors partner with reinsurers rather than primary carriers. Another possibility is the likes of Amazon, Alphabet, Facebook and Apple, with their massive balance sheets, deciding to link up with a reinsurer,” he said.

“You can imagine one of them finding a good Insurtech and buying it, much as Amazon’s purchase of Whole Foods gave it entry into the retail sector.” &

Graham Buck is a UK-based writer and has contributed to Risk & Insurance® since 1998. He can be reached at riskletters.com.