Adjuster X

The Hazards of War

By: | October 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 American approach to the Afghan conflict included a controversial strategy of nation building — attempting political, social and economic reform aimed at improving the lives of the Afghan people. The hope was that the overlapping strategies would eliminate extremism. That challenge appealed to Theresa, a 33-year-old agro-economist. She traveled to Afghanistan with a translator in an attempt to provide support to agriculture.

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When I received the loss notice I had to pause to comprehend the horror of it. Theresa and her translator traveled to a remote location in a southern Afghan province. Arid conditions had depleted the land and the lack of modern farm equipment and seed made matters acute. Theresa met with a community “elder,” who took umbrage at having an American female tell him how to farm.

Before lunch, the translator left Theresa and the elder alone. A younger man approached. The younger man smiled at Theresa, but a moment later he doused her with fluid and set her on fire. Her screams quickly brought onlookers and the translator. Her clothes were sheets of fire as the translator picked her up, ran to a nearby stream and threw her into the water.

The translator called for military assistance. The military medic found Theresa to be severely traumatized.The medic administered morphine for pain relief. A helicopter took Theresa and translator to Kabul where she was hospitalized.

The workers’ compensation coverage information included on the fax noted a Defense Base Act endorsement enabling me to establish an indemnity claim and a provisional reserve. Theresa would stay in Kabul until stabilized and then be transported to Dubai. After the call ended, I met with my supervisor and our claims manager, providing a run-down of the facts. We agreed an international case manager should be hired in Dubai to obtain diagnosis, past history and prognosis.

The next morning, I learned Theresa’s temperature and blood pressure were elevated and she had second- and third-degree burns on her face, torso, upper and lower extremities plus probable internal injuries.

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The first week after the loss was tense. By the fourth week, she was able to make the flight to Dubai. Once there, Theresa would have access to more sophisticated treatment. In Dubai, it was estimated that 45 percent of Theresa’s combined total body surface was burned. Three weeks later, Theresa was cleared to fly to an Army burn-care center in Texas. Indemnity benefits had now been paid for almost eight weeks and I completed an initial significant case report outlining the exposure. Theresa’s weakness precluded walking, resulting in leg swelling and lung fluid build-up.

A week later, she developed a hospital-acquired staph infection. Efforts to resolve the infection took almost two weeks. Theresa continued to lose weight and would require still more skin grafting.

My management team felt the War Hazards Act would apply. With that in mind, a five-year reserve was calculated, at which time the War Hazards Act would take over the benefits directly.

The paperwork was barely completed when the case manager called. Overnight, Theresa had gone into respiratory distress. Gallant efforts were made to resuscitate her but ultimately failed. Her death closed the case.

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]