Return To Work

After Traumatic Injury, Workers’ Comp Thrives with This Return-to-Work Strategy

After a life-changing injury, emotional barriers can hinder a person’s ability to re-enter the workforce. Focus on psychosocial factors is vital.
By: | July 30, 2018 • 8 min read

A workplace accident can leave a worker with a spinal cord injury, an amputation, severe burns or a brain injury, turning their world upside-down. The physical toll is obvious if a worker is missing a limb or immobile. But the psychological hurdles often are hidden.


Recovery can be fraught with emotions, fear and anger among them. This complicated tangle — and the way a person handles it — can reduce the odds that a person will ever re-enter the workforce.

According to studies, employment rates several years after injury hover around 50 percent for severe brain injuries, 35 percent for paraplegics, 25 percent for quadriplegics, just under 70 percent for amputees, and 80 percent for severe burn victims.

Costs are jarring, too. For traumatic brain injuries alone, researchers estimate an economic impact of $56 billion yearly, much of it due to lost productivity.

Experts believe we can do better.

Medical, surgical, prosthetic and technology advances are pushing workers forward. Payers and care management organizations can improve outcomes by putting more emphasis on treating for psychosocial factors.

Set the Tone from Day One

After an injury, it takes time for an injured worker to envision any future. That’s why the psychosocial factors in recovery and return-to-work need to be on the table from day one.

Some might presume that talking to an amputee or a spinal injury patient right away about going back to work would seem callous or create pressure. But most people equate having a job with having a normal life. Talking about work introduces the idea of getting back to normal — even a new normal.

That’s important early on, when the injury seems terrifying. Work offers hope for the future and gives the worker something to cling to when he might otherwise get caught up in “my life is over” thinking.

Marcos Iglesias, senior vice president and chief medical officer, Broadspire

“We’re raised to believe you survive in this world by having a job,” said Zack Craft, vice president of rehab solutions with One Call.

“When you say you may never work again, or don’t know if you can, you have emotional stress and that’s going to impact how you heal and how you think.”

Added Marcos Iglesias, senior vice president and chief medical officer with Broadspire, “One of the things that effective doctors do, and I recommend we claim professionals do, is [to ask] early, ‘What do you like about work?’ It starts getting into the individual’s mind the idea that we’re expecting that they’ll return to work. That work is good for them.”

Setting the stage for return to work can also help counter financial panic.

Said Craft, “[Even if] you’re not worried about today’s bills, you’re worried about your bills in five years. And how are you going to pay for your daughter’s wedding? Are you going to go be able to retire, to travel, and do the things that we all look forward to in our work lives?”

Presented in a positive way, with realistic and achievable steps, talking affirmatively about the path back to work can buoy workers’ health and outlook.

Focusing on the future can be instrumental in helping workers heal from emotional trauma, said Marijo Storment, CEO of ALARIS | Encore.

“There are times when we see injured workers just hang on to the accident or injury so tight that they can’t get past the actual event. That’s a big psychosocial component and can be a [significant] barrier.”

Storment said that workers with traumatic injuries do best when helped to focus on their “new normal.”

The Right Support

The help of an experienced case manager is essential. Beyond coordinating an injured worker’s treatment and physical transition back to home and work, the case manager is in the best position to gauge a worker’s mental state and communicate with the team if a psychologist is needed.


But often, it is case managers themselves who are the primary source of emotional support for injured workers. During a recent webinar hosted by Genex, Jeremy Romero, a former police officer with the Corrales Police Department in New Mexico, spoke about his initial despair after a high-speed chase left him with a spinal cord injury. Romero said his nurse case manager helped to ground him.

As Romero tells it, Genex nurse case manager Trish Elizalde said to him upfront, “I don’t know you yet, but I’m not going to let you give up.”

Elizalde helped Romero understand that as serious as his injury was, “it didn’t mean my career was over, it didn’t mean my life was over.”

“My case manager was my constant support, constant backbone,” said Romero. “Without that, I wouldn’t be where I am today; I am 100 percent certain of that.”

Case managers also support the injured worker’s family, which can help ease worries about how they are coping. Having support helps families set aside their own fears so that they can encourage and care for the injured person.

Matching the injured worker with the best possible rehab facility is also crucial.

“At most centers of excellence … I think there’s more advanced thinking in terms of including psychosocial risk factors in the diagnosis and the assessment even in the earlier treatment,” said Iglesias. “At centers of excellence, they tend to know that [a traumatic injury patient] needs behavioral health support on day one — it’s not an afterthought.”

“There are rehab facilities that are going to be more in tune and provide more extensive psychosocial work toward redefining normal for that injured worker,” said Storment.

A specialized facility can also offer a sense of perspective, and the benefit of seeing others progressing on their journey, said Craft.

“A lot of these regional facilities, they have one or two spinal cord patients in the hospital. You go to the Shepherd Center you’ve got dozens of patients in their outpatient facility,” It’s a lot harder to get stuck in a negative or catastrophic mindset you’re surrounded by hurt just as bad or worse, who are pushing through and keeping a positive attitude, said Craft.

Prepare for the Bumps in the Road

Once a worker is medically ready to come back to work, there is typically a broad range of accommodations and other factors to be addressed to facilitate a successful transition.

Whether a worker comes back to the same job, or to a different job at the same company, or to another job altogether, the case manager will ideally be the one to communicate with the employee, the employer and the treatment team and assure a fit that works for both employer and employee.

Zack Craft, vice president, rehab solutions, One Call Care Management

“We want to make sure when they go back … they’re doing work that they see as valued,” said Storment. “The injured worker doesn’t want to be there just to check a box.”

The work environment can present challenges for a worker’s new needs. Some workers might need a private place to administer medication, for example.

With a spinal cord injury, there are bowel and bladder issues to be considered. A quadriplegic could have specific feeding needs. Such situations may not always have easy answers.

Consider, for example, an amputee who needs to take his prosthetic off from time to time, said Craft.

“That prosthetic gets hot and gets heavy. Your skin itches and you say, ‘I want to take that thing off,’ and suddenly everybody’s all, ‘Oh my, you just put your hand on the table!’

Not every employee is emotionally stable or emotionally mature enough to handle that type of situation. How do they address that?”

Part of it, he said, is reaching out to that employer and preparing them and saying to them, “He’s going to come back different, there are going to be complications. There are going to be some things that need to be addressed, to be aware of.”

“We have to really be proactive,” said Storment. “We’re not going to solve every barrier before we get there. But if we try to create a clear path, that return-to-work milestone is going to be much more successful.”

Opportunities for Faster Engagement

To accommodate workers whose needs might be too difficult or uncomfortable to manage within the workplace, working from home could be a viable option.

“Ten years ago, an individual with a spinal cord injury’s return to an office environment was wrought with obstacles,” said Craft, “both because of the physical challenges and difficulties engaging with the rest of the workplace.”


“But fast forward to today. Say a top salesperson was in a [work-related] car accident and there’s a spinal cord injury. They’re not ready to return to work emotionally and physically, or the company may not be ready for it. Today, the scenario could be, ‘Let us set up your home office.’

“We’re not pushing individuals that way yet today, but that’s where I would like to go,” he said.

“We want to bring them back into the company as fast as we can – no matter what it is they can do – and it doesn’t have to be a lot.”

First Change Industry Mindset 

Part of the challenge, said Craft, is getting other stakeholders to think differently about how they handle catastrophic injury cases. Too many people across the industry think “Oh it’s a spinal cord injury. He’s not going to return to work,” said Craft. “They see it catastrophically.”

It’s important to have a strategy, have a goal, and track that goal, he said.

“Let’s put a date out there and let’s make everybody accountable. These individuals should return to work to some level,” he said.

Broadspire’s Iglesias is in agreement. “Have a written plan. Identify the stakeholders, identify the possible jobs and tasks that are available. Identify where the individual is today and where [the treatment team] thinks he might be in X number of weeks.” &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.


Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.

R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.


We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?


Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.


Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now an where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.


More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

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