Risk Insider: Dan Holden

In Praise of the Hippo

By: | October 1, 2014 • 2 min read

Dan Holden is Manager of Corporate Risk & Insurance for Daimler Trucks North America (formerly “Freightliner”). He manages the risk management program in the U.S., Canada and Mexico. He can be reached at [email protected]

When I was a fledging claims examiner, I was taught the universal file mantra: “Res Ipsa Loquitor” (the thing speaks for itself). In claims terms, it means the file should tell the story.

Not a difficult concept if you think about it. I suppose a less classy version would be, “if it ain’t written down, it didn’t happen.” But Res Ipsa Loquitor is more than just jotting down crib notes in a file. It’s about documenting the direction in which you are headed and why.

A second, equally important mantra came from a former claims manager who said, “… if you were hit by a bus, someone should be able to pick up your file and know exactly where you left off.” He went on to say that could only be achieved through clear, copious, and comprehensive documentation.

As a senior workers’ compensation claims consultant, I often dinged examiners for poorly documented files and a dearth of a memorialized thought process. Occasionally, their response was akin to, “well, obviously you don’t know Alaska comp!” (or whatever state I was auditing).

“… if you were hit by a bus, someone should be able to pick up your file and know exactly where you left off.”

While I realize they were just being defensive, they missed the point entirely. I wasn’t criticizing them for something statute-related; I was simply telling them they failed the Res Ipsa Loquitor test which is the most critical common denominator in all the various ‘Best Practice’ file criteria available.

An employer always has the right to know how/why a certain decision was made. Pronouncements made by insurance companies and TPAs — which obviously effect the employer — should never be made in a vacuum.

In my claims manager days, I came up with a whimsical way for my staff to “visualize” the documentation process. I called it “HIPPO.”

HIPPO
History: What happened? Who/what/where/how?
Issues: How serious was the injury? Is there time-loss involved?
Plan of Action: What is the examiner’s initial plan? Is return-to-work possible?
Procedure: How will the examiner begin the compensability process?
Outcome: What is the examiner’s best guess at this point?

Obviously, HIPPO would need to be revisited from time to time as the file matures and becomes more complicated. And, of course, the compensability aspect of the claim would be much different than a plan of action for ongoing medical management.

But you get the drift. And, yes, I found little plastic hippopotamuses which I placed on their desks to help them remember!

For the younger generation, who seem compelled to use social media to document what they had for breakfast, perhaps this concept will come easier.

Then again, documenting what you ate is a far cry from explaining why you chose that particular food item; why it was the best choice over all others; why it made financial sense; and what gastronomical ramifications might ensure because of said choice. Bon appétit.

Read all of Dan Holden’s Risk Insider contributions.

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]