Column: Workers' Comp

Double Duty

By: | August 4, 2014 • 3 min read

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

A classic risk management refrain proclaims that the best claim is one that never happens. Another workers’ compensation maxim holds that 20 percent of claims drive 80 percent of costs.

Taken together, the two pieces of wisdom explain why, with good reason, we in workers’ comp spend so much time focusing on medical care management, yet also strive to prevent and mitigate claims early, before they require extensive medical management services.


As an editor and co-chair for the National Workers’ Compensation and Disability Conference® & Expo, I have at times focused greater attention on medical management topics than on risk reduction and loss-control practices.

Doing so makes sense because medical expenses now account for more than half of a claim’s cost, on average. It’s also important to dig into the growing array of medical management services for injured workers to evaluate how claims payers effectively apply those services.

But a recent conversation with Tom Tobin, CEO and partner at Fit for Work LLC, pulled my attention back to the importance of reaching workers before soreness, minor aches and discomfort grow into claims needing greater medical care and management of medical services.

Tobin advocates engaging workers early, encouraging them to step forward when they first experience discomfort. Workers typically strive to be productive and focus on providing for their families, often ignoring early warning signs until they become recordable injuries and significant claims, Tobin said.

I have heard this is especially true about a company’s most productive workers. They are more likely to shrug off the early warning signs. There is also fear that reporting an injury might be negatively perceived.

A focus on medical management shouldn’t come at the expense of developing solid safety and risk management practices, like fostering a workplace culture that encourages employees to speak up when they first experience discomfort.

But physical therapists can periodically visit a workplace and develop relationships with workers, sending a powerful message that it is safe for employees to step forward when they first experience work-related aches, Tobin said.

The therapists can then develop stretch and flex routines, suggest work-performance modifications and provide other assistance that mitigates claims.

Acting to prevent injuries and mitigating their severity early on is a basic concept risk managers have advocated for decades.

But employers still struggle with soft tissue injury claims and their costs can mount, especially with a workforce that is growing older and heavier.


Still, with medical care now driving such a large portion of a claim’s total cost, it’s also obvious that medical management services helping deliver the right care have an important role when applied in the right dose.

Clearly, a solid mitigation strategy requires both, addressing the challenging open cases with their ongoing medical expenses, and preventing new injuries or identifying them before they become part of the 20 percent.

A focus on medical management shouldn’t come at the expense of developing solid safety and risk management practices, like fostering a workplace culture that encourages employees to speak up when they first experience discomfort.

That is why, as an editor and conference producer, I’ll work to provide information that helps professionals tasked with reducing losses understand evolving claims management trends while also promoting practices that result in those claims never happening.

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]