2017 NWCDC

Coordination Closes Complex Claims

Like on the baseball diamond, a "double play" in workers' comp demands a team mentality.
By: | December 8, 2017 • 2 min read

Many claims examiners face complex cases that snowball out of control, seemingly out of nowhere. Claims involving opioids, injuries to multiple body parts, comorbidities, high reserves, suspected fraud or scheduled litigation quickly become high-exposure cases.

Barry Bloom, principal, The bdb Group

Closing these claims is critical not just for workers’ compensation providers, but for injured workers as well – a lengthy and expensive claim benefits no one. To rein in these cases, claims examiners can implement a “double play.”

Barry Bloom, principal, The bdb Group, laid out this strategy in a Dec. 7 session at the National Workers’ Compensation and Disability Conference & Expo in Las Vegas titled “The Double Play Process: A Blueprint for Closing Complex, High Exposure Claims.”

In baseball, turning a double play requires coordination among multiple players. Same goes for a “double play” in workers’ comp.

The term refers to a face-to-face meeting of all the key players in a claim, including the claims examiner, defense attorney, investigator, structured settlement partner, MSA partner and excess carrier. The goal is to walk away from the meeting with a specific plan of action for resolving that claim.

“You’re not doing a file review of 22 cases; you’re focusing on one. You need a ‘do it now’ mentality.” – Barry Bloom, principal, The bdb Group

The claims examiner acts as “team captain” and ensures that every participant has comprehensive information about the claim. But every player has to come prepared as well – coordination can’t happen if stakeholders don’t know the claim details inside and out.

The key is to remain focused on the case at hand and maintain a forward-looking perspective.

“You’re not doing a file review of 22 cases; you’re focusing on one,” Bloom said. “You need a ‘do it now’ mentality.”

When executed successfully, a double play can expedite claim closure at an appropriate cost, help to re-evaluate and fine tune reserving, and provide a measure of quality control for the claims team.  &

Katie Dwyer is an associate editor 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.


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]