Adjuster X

Northern Lights Out

By: | September 15, 2013 • 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]

The prospect of working in Alaska managing a pipeline project wasn’t easy for a California native. But Anne needed the money and the career boost. Being away from her boyfriend would be difficult, but they both felt the opportunity was a good one.

The project’s first season had been completed and a night-time wrap party was held.

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Soon after, I received a fax from our Anchorage office alerting me to a potentially substantive loss. Information was minimal: A 32-year-old woman, a project manager for an international construction company, had fallen from a moving snowmobile while leaving a party.

She had a skull fracture as well as rib and arm/hand fractures. She had an extremely guarded prognosis. I needed more details before I could make a determination of compensability.

There wasn’t any problem in coverage verification as the self-insured had primary and excess workers’ compensation and general liability coverage.

My first call was to the employer’s national risk manager. He said Anne was hired five months prior, tasked with overseeing a pipeline renovation in Alaska. When the construction ended, she was to return to California and work for the firm until the next phase launched six months later. Her salary would place her at the maximum benefit rate.

Of her known injuries, the skull fracture was the most serious. She wasn’t likely to return for the project’s next phase. Anne was triaged at a medical clinic 30 miles from the injury site before an air-ambulance flew her to Anchorage.

I contacted the safety director and asked if it was mandatory that Anne attend the party. He said no but added that project managers typically attended these events. A number of other attendees told the safety director that Anne did have a few drinks and a light meal and left after dark with a co-worker.

The safety director, after speaking with the police, confirmed that the driver had to swerve to avoid hitting an animal and Anne fell off the snowmobile. It was unclear whether or not she had worn her safety restraint. The police didn’t require the driver to take a Breathalyzer test. He said he drank two glasses of wine.

From the field case manager, I obtained the diagnosis: Anne had a frontal lobe traumatic brain injury, with fracture injuries of the right arm/hand and two ribs. A craniotomy was done to reduce the pressure on her brain.  The case manager said that Anne would remain in the ICU for two weeks, then go to a step-down unit before transfer to a post acute facility.

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I discussed the case with our claims manager and it was agreed that we would initiate indemnity benefits.

With the case manager, we established a discharge date for Anne and a transfer to a San Diego rehab center. Anne had residual problems with her speech, vision and right hand.  A local field case manager was assigned to follow her regimen of occupational, speech and physical therapy.

Anne remained motivated, and the employer willing to accommodate her, despite the fact that she would miss the second construction season.

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]