Adjuster X

A Fast Food Nightmare

By: | October 15, 2015 • 2 min read

This column is based on the experiences of a group of long-time claims adjusters. The situations they describe are real, but the names and key details are kept confidential. Michelle Kerr is the editor of this column and can be reached at [email protected]

Millie Ramos was using twin deep-fryer baskets at Express Burgers & More when she sustained severe burns to her eye and both hands. The locks wouldn’t release when she attempted to remove the flyer baskets.


When they remained stationery, the force caused her hands to go into the hot oil. Her screams brought the place to a standstill.

“She was half slumped over the frying area with her hands still in the basket and in shock,” her supervisor told me.

He and some co-workers moved her over to a chair and wrapped cool towels around her hands. Her upper face and left eye had been splattered by the hot oil.

Our settlement offer was based on a body as a whole impairment. This was accepted, bringing to an end a very painful case.

Millie, a 21-year-old single mother hired just nine days prior, was hospitalized in a burn care unit.

When I spoke with manager Ed Stanton about the basket locks, he noted that the locks “normally are quick to release with just a bit of pressure. I can’t fathom why this one didn’t.”

The branch had been using that particular unit for three years, with no previous issues reported.

Ed said that Millie “had our usual on-the-job training … shadowing an existing employee to get the hang of things,” but there was no fryer-specific training.

“Had Millie been required to wear a hairnet or protective gear?” I asked.

“Yeah,” he replied, “a hairnet of course and we do provide plastic glasses, but I don’t know if she was wearing them.”

I asked how often the fryer was cleaned and inspected, to which Ed said, “When it needed to be. But it’s always in use.”

My next question surprised him. I asked whether Millie drank alcohol. He retorted, “Well, it’s not for me to know or say, is it?”

The case manager and I spoke later. Millie had third-degree burns on both hands requiring extensive cleansing of the dead skin, a lot of intravenous fluid drips, antibiotic creams and pain medications.

Subsequently, there’d be numerous skin grafts. Her eye was washed and medicated drops used. No loss of the eye itself was expected.

Our case manager hesitated a few seconds after I asked if there was any blood alcohol testing.

“The claimant was in acute distress, actually shock,” she said. “They needed to stabilize her, so nothing of that sort was done.”

Millie’s prognosis remained guarded.

She was unable to work, unable to care for her family, unable to drive, and she experienced recurring nightmares.

After discharge there would be physical therapy and eventually work hardening. Return to work was estimated between 4 and 6 months. A homemaker would be required to care for Millie’s young daughter.

I spoke with the corporate risk manager, Frank Duclos, about the mechanics of the injury.


Polite, but circumspect, he only disclosed that “we’ve taken a look at it and nothing untoward was found.”

I concluded nothing else would come of the issue.

Case management reports reflected limited progress over the next few months. The claimant continued to have nightmares and crying bouts.

Six months passed with no return to work. When Millie was discharged to regular duty, we scheduled an independent medical exam.

Our settlement offer was based on a body as a whole impairment. This was accepted, bringing to an end a very painful case.

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.


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.


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]