Adjuster X

Here’s Looking at You, Kid

By: | March 2, 2016 • 4 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]

An emergency room visit for an eye problem didn’t seem to be very out of the ordinary. The accident report was from Baker’s Day Care Center and the cause of the injury simply stated “foreign substance in eyes.”


Marie Fletcher was the injured employee in this matter. She was a 64-year-old worker at the day care center. The incident had transpired two days before, and Fletcher was not yet back at work. With a three day waiting period for lost time in this state, the claim was on the cusp of being an indemnity case.

I arrived at Fletcher’s apartment complex and made my way to her unit. I rang the doorbell, and heard a female say, “Please wait a minute. I’ll be there shortly.”

The door soon opened and a woman stood before me with a bandage on the right eye, and dark glasses on.

I introduced myself and was ushered into the kitchen where we sat at the table.

“Ms. Fletcher, I have the report of the incident indicating you suffered an eye injury at work. However the report merely states you sustained a foreign substance in your eyes. I need to understand how the accident occurred.”

Fletcher looked at the floor and cleared her throat. “Well, it was rather, er, ah …embarrassing.” I reassured her there was nothing to worry about in recounting how the incident transpired. As the investigator for the workers’ compensation insurer, I explained, I had to know.

Not Your Typical Workplace Hazard

Fletcher again hesitated before saying, “Little Tommy Flanagan, he … he peed in my eyes.”

I looked up from my note pad, and said, “Sorry, what was that?” Fletcher reiterated the statement.

At this point I was trying mightily to keep a straight face. “Ms. Fletcher, please explain how that incident occurred while you were doing your job at Baker’s.”

“Well, Tommy, who is three years old, has a minor urinary tract infection. His mother had reported this to us and he was on antibiotics to treat it,” she said.

“But Tommy kept wetting his pants that day. I had changed him twice already. The third time in late afternoon was when it happened.”

“Please go on,” I urged.

“I had picked him up and placed him on the changing table. I pulled his pants off to begin the process when he suddenly, ah, let loose,” Marie said. “It caught me largely in my right eye, although the left eye was splattered too. It burned and irritated my eyes. I involuntarily screamed, and that’s when Terry ran into the room.”

“And Terry is …?” I inquired.

“Terry Boyce. She’s my boss. I tried washing my eyes out with water but they still were irritated and I couldn’t focus very well.”

“How did you get to the ER?” I asked.

“A coworker drove me. I was treated at the ER,” she said.”They irrigated both eyes and gave me some drops. They told me to stay off work and follow up with my eye doctor. I have an appointment with him tomorrow morning.”

“Please alert your doctor that I will be calling him to obtain the results of the exam,” I replied.

I thanked Ms. Fletcher for her cooperation and made my way to Baker’s Day Care Center. I met with Terry Boyce about the incident.

“Most unfortunate circumstance” was her comment.

“I heard Marie scream and immediately ran into the room where she had Tommy. She was holding her hand to her face and groping to find a towel,” she said.

“Ms. Boyce, why would you allow Tommy to come to day care if he was ill?”  I asked.

“His mother told us he had a slight urinary tract infection and he was already on antibiotics to treat it,” she replied.


“She indicated he seemed fine, and the antibiotics would clear the infection up shortly. She had an important business meeting that day and said she couldn’t stay home with him. She asked us to please take him. He’s a good child. Other than the urinary tract problem he appeared to behave normally.”

I thanked her for the information, and headed back to my office. My supervisor dropped by my desk and asked about the Fletcher claim investigation.

“Oh, I just completed that,” I said. “It was a real pisser.”

He looked at me and said, “I’m sure I’ll find out about the investigation — and your remark — shortly.”

The next morning I called Fletcher’s eye doctor who cleared her to return to work. I hoped he suggested safety glasses for her during any future changing duties.

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]