Adjuster X

Caught in the Act

By: | September 15, 2014 • 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]

I was shaking the cobwebs out of my head. Some adjuster friends and I had closed the pub at 2 a.m. the night before. Thankfully, my first call was a simple activity check. I was feeling queasy as I parallel-parked my car in the neighborhood of the claimant, James Parson. I took two aspirins and a swig of coffee, and squinted at my paperwork.

James was claiming total disability. His case had not had been previously adjudicated as temporary total or permanent total disability, so I knew it was in active litigation.

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I rang the doorbell at the nearest house, trying to collect myself so I was coherent when I introduced myself. But there was no answer. I rang again and waited. Still no answer.

At the next house, a woman in her fifties answered. I asked her if she knew her neighbor, James Parson. She said she wasn’t all that friendly with him and his wife, and knew nothing about his present activities.

At the next house, a young woman with two small, screaming children said she was too busy to talk. The aspirin hadn’t kicked in just yet — my headache was still pounding.

The woman at the next house said she’d seen Parson home a lot lately. She said she hadn’t seen him cut the lawn or do any work around the house in a while, which she said was quite unusual. I thanked her and moved on.

I decided to try just one more house. A man in his sixties greeted me, and invited me in for a cup of coffee. More coffee was sounding like an excellent idea right about then.

The man’s name was Bill. In the kitchen, he introduced me to his friend, Jim, who also had a cup of coffee.

“Thanks so much for your hospitality,” I said to Bill. “I need to ask you a few questions about your neighbor, Mr. Parson, and then I’ll get out of your hair.

“Do you know Mr. Parson well?” I asked.

“Fairly well,” he replied.

“I’m trying to determine what you may have observed about his level of activity around the house over the last several weeks,” I explained.

Bill thought for a minute, and said, “His level of activity appears to have declined over the last few weeks. In fact, I’d say he is pretty sedentary at this point.”

I asked if he had seen him driving. He said no, not much at all. I asked, “Do you know if Mr. Parson has any significant physical disability of any type?”

He looked at me, and then at his friend and said, “Jim, do you have any significant physical disability besides your work-related problems?”

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I swiveled my head and stared at Jim, who was looking back at me wryly. “Oh, by the way,” Bill said, “This is Jim Parson.”

I almost fell out of the chair. “Ask me anything you like,” Jim said. But Jim was represented by counsel, and I was already in hot water.

Bill chuckled as I stammered, “I’m so sorry. I’ve got to go now. Thanks for the coffee.” I made a beeline for my car.

No surprise — by the time I returned to the office in the afternoon, there was already a call from Parson’s attorney, complaining about me speaking to his client without representation. Thankfully, he believed my explanation about the accidental meeting.

I left the office that afternoon ruing the beer-induced haze from the night before that deadened my senses and turned my easy assignment into a job-threatening tangle.

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]