Lawyer Involved? Drive for Swift Resolution
Even after an injured worker “lawyers up” for a workers’ compensation claim, the best policy for all stakeholders — worker, employer, claims manager and carrier — is to press for a swift, equitable resolution while maintaining empathy and sound medical care, attorneys and claims managers agree.
When attorneys get involved, said Edward E. Canavan, vice president, workers’ compensation practice and compliance, Sedgwick Claims Management Services, Inc., claims typically cost eight times more and lost time from work increases by three hundred percent.
Facing exponentially higher costs, the insurance community’s reflex “may be to dig in its heels,” said Canavan, but negotiation and compromise are usually more productive when dealing with attorneys, who are skilled in securing compensation.
“Focus on the resolution,” he advised. “Be assertive, manage the claim, pay all benefits due, but don’t be overly aggressive just because the case is litigated.”
By the time an applicant has lawyered up, said Bernie Baltaxe, partner, Smith & Baltaxe, LLP, who represents injured workers, the adversarial process has already begun simply by nature of litigation, “but the case has not necessarily gone south.”
Be assertive, manage the claim, pay all benefits due, but don’t be overly aggressive just because the case is litigated.— Edward E. Canavan, vice president, workers’ compensation practice and compliance, Sedgwick Claims Management Services, Inc.
Workers generally seek legal representation, Canavan said, because they haven’t given the carrier a chance to do the right thing, are fearful and anxious because they don’t know what to expect, or are angry, often about denial of treatment.
Most of his clients seek his representation, Baltaxe said, knowing that part of the claims adjustor’s role is to control costs. Fearing the execution of that role will come at their own expense, “they don’t trust the insurance company or claims adjustor 100 percent.” And sometimes trust decays because they simply can’t reach the claims adjustor on the phone.
Communicate, Communicate, Communicate
The best possible strategy for litigation, Canavan said, is to avoid it. Workers’ inclination to hire an attorney starts long before an injury. Disgruntled employees, and those who don’t understand workers’ compensation and return-to-work policies, are more likely to lawyer up.
As a preemptive move, “employers can educate workers about workers comp to manage their expectations.” This may include information about what workers’ compensation covers and doesn’t cover in their jurisdiction, protocols for diagnostics and procedures and how to select doctors within workers’ comp medical networks.
The communication changes to an advocacy role after an injury. For the claims examiner and the employer, Canavan said, that means a constant stream of messages about recovery, education and empathy.
To manage the injured worker’s fears and anxiety, he said, the messages should start immediately and be tailored to the individual. “The claims manager should ask, ‘Is the injured worker demonstrating concern around returning to work? Is he worried about how to take care of himself and his family during his recovery?’”