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

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.

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]