Adjuster X

As Time Goes By

By: | February 18, 2014 • 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]

Richard Cochran, a driver for Goodwin Employer Messenger Service, claimed he broke his right arm on the last run of the day when he slipped and fell getting back into the van. I arranged to meet the owner, Bill Goodwin, and we went over the routes Cochran had been assigned for the day. The weather that week had been dry and sunny, so it certainly wasn’t a case of a rain-induced slip and fall.

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Goodwin told me that after falling, Cochran had gone to the local ER, where an X-ray confirmed the broken ulna, and he was casted. Cochran was right-hand dominant, but he drove the van back to his residence for the evening and then called Goodwin to let him know.

I called Cochran to set up an in-person interview, but first I wanted to speak to the people at the printing company that was Cochran’s last delivery that day.

The receiving clerk who signed for the delivery recalled it was about 4:45 when Cochran arrived. She had noted it because it was just shy of closing time. She admitted she had not seen Cochran get back into his vehicle because she was rushing to finish her paperwork for the day.

I checked the street in front of the print shop and didn’t notice anything unusual such as construction or road work.

I then went to Cochran’s home to take his statement. He went over the route for the day, and how he fell while getting back into the van at approximately 5 p.m. He said it hurt so much that he decided to go to the ER for treatment and that he had arrived at the ER after 6 p.m.

I asked why it took over an hour when the ER was only 15 minutes from the print shop. He said there was rush hour traffic, he had originally started driving to his home before changing his mind, and that he was driving slower than normal because he could only grip the wheel with his left hand.

All of this made sense. I thanked him and headed directly to the hospital where Cochran had been treated. The ER report appeared normal, but the time of processing was listed as 7:15 p.m. That seemed odd. My antenna was up.

The next morning, I went back to Cochran’s home with only 30 minutes’ advance notice. I asked him to explain the gap between leaving the print shop at 5 p.m, and showing up in the ER at 7:15 p.m. He stared at me blankly but remained silent.

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I finally said, “After leaving the printer, you went somewhere else before you went to the ER. Where was it?” More silence. I said, “Look, if you tell me the truth, we can prevent the authorities from investigating the claim under the insurance fraud statutes, but you have to be honest with me.”

He finally said, “I went to The Rathskeller (a local tavern, about five minutes from the ER) to play a quick game of darts.” I asked how many drinks he had while there. He said, “I swear I only had two beers. When I was getting back into the van, I slipped and fell on my right arm. I wasn’t drunk. But I was afraid of what would happen if Bill found out I had the company van with me.”

I advised him that I was denying the claim under workers’ comp for obvious reasons, and that I was going to call Bill Goodwin and explain everything to him.

Telling the truth spared Cochran from criminal charges, but — not surprisingly — Goodwin terminated him for lying and for unauthorized use of a company vehicle. I shook my head as I mused that Cochran should have embraced the axiom that honesty is the best policy.

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]