Nurse Case Manager Chronicles

Empowering Injured Workers to Heal

Educating injured workers provides them with a sense of control over their care and their recovery.
By: | May 1, 2018 • 4 min read

An encounter with a patient early in her career as a case manager taught Lisa Armstrong a lesson that would influence her approach to all of her patients gong forward.

The case involved a worker who’d suffered a painful knee injury on the job.

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“He was a good, hard-working, blue-collar worker,” she said. He was dedicated to his job and his family and delayed seeking treatment, instead working with a bad knee. When the pain became too unbearable, he finally filed for workers’ comp.

“He had a meniscus tear,” recalled Armstrong, a nurse case manager with Genex Services, which specializes in medical management. “And after everything, his knee never quite returned to the way it was before.”

Armstrong went with the injured worker to a follow-up appointment. She sat in and listened as the doctor explained the injured worker’s options.

“The doctor was hesitant to suggest what he would recommend for another patient [who didn’t have workers’ comp].”

As a nurse, she was cognizant of medical solutions that would have helped in this scenario. The doctor could have suggested knee replacement surgery, but instead he did not mention it.

Armstrong speculated that the injured worker’s status as a workers’ comp patient caused hesitation, and “because of pre-existing osteoarthritis and because he was a workers’ comp patient,” Armstrong said the doctor most likely feared workers’ comp would not pay for the surgery and so did not recommend it.

Lisa Armstrong, nurse case manager, Genex Services

“But it’s not always about the claim. It’s about the person.”

Armstrong left the appointment feeling like she could do more.

“I felt like this patient needed empowerment.”

She spoke with the injured worker about knee replacement surgery, explaining it would be unlikely workers’ comp would cover it, but it was still an option he could pursue on his own. With Armstrong’s advice in mind, the injured worker had the surgery using his personal insurance.

“He was [planning] to live the rest of his life with a bum knee; now he can get back to work and be with his kids like before.”

It was a turning point for Armstrong: Empowering employees, giving them the information they needed to make their own choices, would be central to her case managing.

Building Trust

For Armstrong, who started her career as an acute care and rehabilitation nurse 15 years ago, the best thing nurses can do to ease the workers’ comp process is to build trust with injured workers. From that trust, empowerment will grow.

“An injury is an abrupt change of life. At the beginning, many don’t know which way is up.”

Armstrong speaks from experience. Her own daughter suffered a traumatic brain injury a few years back.

“I’m in the [medical] profession, and I was overwhelmed,” Armstrong said. “I can’t imagine what it’s like to not be a part of this [profession] and go through this type of event.”

Armstrong has a passion for educating workers during their transition from hospital to home. For her, case managing is both a healing process and an outlet to give back.

She said she was blessed with good people in her own journey; her hope is to help guide others.

“Sometimes a patient is left stumbling along in the dark. That first contact is important. It sets the tone [for the claim] early on.” — Lisa Armstrong, nurse case manager, Genex Services

Healing is a team effort, she added. Empowerment should be, too. Armstrong said when an employer shows they care about their worker’s needs, she’s seen more positive outcomes. Likewise, when a doctor talks to a patient and the insurance is accessible and responsive, workers tend to participate more in recovery.

Injury and illness of any kind can be scary. One day, a person is perfectly fine and the next it’s a slew of doctors, nurses, tests and monitoring. Add in the complicated world of workers’ compensation, and an injured worker can become overwhelmed and disheartened.

“The first contact a worker has after injury is their employer. I hear all sort of things, both good and bad,” said Armstrong. “Sometimes a patient is left stumbling along in the dark. That first contact is important. It sets the tone [for the claim] early on.

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“My heart is with trying to get a patient the education that they need,” said Armstrong. This education, she explained, extends beyond getting the patient home; it’s education that teaches them about their injury or illness and gives them a sense of control over their own health.

It’s the practice of empowerment — giving injured workers respect and listening to their needs, wants and fears, while also educating them about their recovery.

“A patient who has been heard, who feels respected, actively participates in their recovery,” Armstrong said. “The underlying important piece of empowerment is information.

“Show them what their rights are as an injured worker. Nurse case managers have a code of ethics: Advocate for the patient,” she said.

Giving an injured worker the tools to understand the claims process, supplying them with background on their particular type of injury and opening up every option available for recovery — even options not available through workers’ comp — empowers an injured worker to feel confident and actively participate in return to work.

“It doesn’t always come down to dollars and cents,” said Armstrong. “A positive outcome is good, because you have a positive employee who won’t seek legal action. You have a patient with no reason to seek outside resources who wants to get back to work.” &

Autumn Heisler is the digital producer and a staff writer at Risk & Insurance®. She can be reached at [email protected]

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]