Adjuster X

Tragic Taxi Ride

By: | August 1, 2013 • 3 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]

A 49-year-old chemist working in Frankfurt, Germany, was left paralyzed after her taxi got into an accident. There were tremendous complications and plenty of questions for me to attempt to answer, all while I worked the case from the United States.

Would she ever walk again? When could she fly back home?

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Soon enough, the details started trickling in.

An elderly man driving in the wrong direction struck the taxi. The driver and another passenger were killed and the claimant was trapped in the backseat. The police came quickly but struggled for almost an hour to free her from the wreckage. The ordeal left her with a spinal cord fracture forcing doctors to perform a spinal fusion.

During a conference call with the risk manager, it was made clear to me that this employee was highly valued and that we were expected to do everything humanly possible to assist her and her family. That included the prompt initiation of statutory benefits and referral to a local nurse case manager.

I set the medical reserve projection to $500,000 but knew that the ongoing hospital costs, repatriation and potential for home and car modifications would increase costs to the million-dollar range. I requested that our Brussels office send a field claim representative and nurse case manager to Frankfurt to meet with the claimant, her family and physicians.

More details started coming in. The European nurse case manager reported comorbidities including obesity, Type 2 diabetes, high blood pressure, high cholesterol and elevated liver enzymes. The claimant was running a high fever, suggestive of a massive infection, and the German doctors weren’t sure if she would live.

Surely, it would be a while until she could return home.

By the fourth week the claimant’s condition could best be described as a roller coaster — after one infection was brought under control, she’d be plagued by another. She remained bedridden without even light physical therapy. I knew that unless she got some time out of the bed, she would risk getting blood clots and bedsores.

Meanwhile, back in the States, an attorney representing the claimant said the proper jurisdiction should be Connecticut (and its higher weekly comp benefit maximum rate), not Pennsylvania. She lived in Pennsylvania but had a child attending college in Connecticut so the carrier obliged.
By week eight, it was time for her to come home. I lobbied for a facility specializing in spinal cord injury, but the claimant instead elected to be in a hospital closer to her children.

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Within days of her return, the fever resumed along with severe back pain. It was discovered that one of the screws in the spinal hardware was loose. She underwent surgery to tighten it, but the pain and fever persisted. Doctors decided to remove the original spinal hardware and re-stabilize the spine.

Through it all, the claimant was confused and her words were muddled at times. A neurologist found that the German hospital admitted her in a semi-conscious state and that her actions were suggestive of a brain injury.

In yet another surgery, the neurologist removed a small brain hematoma.

The claimant’s condition was finally stabilized. Now, she could begin to adjust to daily life. She even began working again by using video conferencing.

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]