Adjuster X

Northern Lights Out

By: | September 15, 2013

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.

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The R&I Editorial Team can be reached at [email protected]