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NWCDC Session Preview

There’s a Better Way to Get Stubborn Claims Unstuck

Claims involving chronic pain require a customized approach to avoid stalled progress and snowballing costs.
By: | June 11, 2018 • 3 min read
Topics: Claims | NWCDC | Workers' Comp

Standard claims management and medical-care delivery practices often lack the ability to resolve “stuck” claims that drag on while costs mount and claimants grow frustrated with chronic symptoms.

Traditional medical care also doesn’t acknowledge the reasons why claims get stuck and doesn’t provide proper interventions for overcoming those obstacles. That’s what prevents a positive resolution in many cases, said Jennifer Christian, a medical doctor and president and chief medical officer at Webility Corp.

Jennifer Christian, president and chief medical officer, Webility Corp.

The claims management process, meanwhile, often ignores the circumstances causing claims to spin out of control, or it focuses on defending against them, rather than applying the right strategies for preventing them from becoming problematic, Christian added.

Christian is among three medical doctors with years of experience treating workers’ compensation patients who will deliver a presentation titled “Getting Difficult, Frustrating and Expensive Claims Unstuck” during the 2018 National Workers’ Compensation and Disability Conference & Expo.

NWCDC is scheduled for December 5-7 at Mandalay Bay in Las Vegas.

Typical claims management processes and traditional care delivery methods often lack appropriate measures for resolving the 15 percent of difficult cases that drive 85 percent of claims payer costs, agreed Steven D. Feinberg, a pain management physician at Feinberg Medical Group.

He will join Christian and Lee Glass, associate medical director for the state of Washington’s Department of Labor and Industries, to deliver the NWCDC presentation.

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“It’s actually more than just the medical treatment it’s the system itself,” including the claims management process that can hamper resolving the claims, Feinberg explained.

“We have more or less a medical care process that is one size fits all and a claims management process that is one size fits all,” Christian added.

Both systems apply a unidimensional approach to injured worker needs, Christian said. They ignore factors that can exacerbate claims as they progress, she added. Those factors can include the actions of employers, employees and doctors.

System shortcomings are common, Glass said.

“The system really is lacking in a lot of ways,” he said.

For example, the system is set up to treat the majority of injured workers who suffer acute pain. They often quickly proceed through the workers’ comp system and move on after their injury.

But the system doesn’t do so well for workers suffering from chronic pain, in contrast to acute pain.

“People who go on to develop chronic pain have a different set of needs. Those folks have needs that the system has not yet been designed to meet.” —  Lee Glass, associate medical director, Washington Department of Labor and Industries

“People who go on to develop chronic pain have a different set of needs,” Glass said. “Those folks have needs that the system has not yet been designed to meet.”

Injured workers suffering chronic pain often experience a change in brain functioning, Lee said. Their emotional circuits get turned on, often resulting in their increased levels of emotions such as anger and frustration.

“Right now the way the system works is they are treated just like everybody else (but) they don’t recover like everybody else,” Lee elaborated.

They may turn to attorneys and could find themselves in a system that becomes more adversarial and polarized rather than collaborative to resolve the underlying problems.

The three doctors will discuss early-intervention strategies to recognize claims with the potential for becoming stuck.  They will also draw on their experiences resolving real-world claims to explain measures for getting the difficult claims unstuck and moving toward a positive resolution.

Visit the NWCDC conference website for more information about this year’s event. &

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

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The R&I Editorial Team can be reached at [email protected]