Top 10 Lessons Learned in Helping Workers Move Past COVID-19

Here are the top lessons workers' comp pros have learned about COVID-19, its impact on the workplace and on how to help employees get back to work after illness.
By: | September 24, 2020

There’s no doubt COVID-19 has had an impact on the workplace. Not the least of which is the mental and physical struggles that employees who’ve been affected by the illness may experience as they return to work.

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There are about 6.65 million confirmed cases of COVID-19 in the U.S. and nearly 200,000 people who have died from the illness as of writing. With such high numbers, employers are striving to provide safe workplaces and to help workers feel confident about moving past the illness.

Tammy Bradly, vice president of clinical product development at Coventry, and Tim Howard, senior vice president of field case management for Genex Services, discussed the top lessons they’ve learned about COVID-19, its impact on the workplace and how to help employees get back to work after the illness.

Here are the lessons they’ve shared:

1) COVID-19 Is Different from Other Illnesses

“It’s very different,” said Bradly.

“The most common injury types we typically see in workers’ compensation are musculoskeletal in nature. With COVID-19 you can’t just give someone a pill or put them in a cast for a few weeks, send them to physical therapy and then back to work. With COVID, we’re still learning about the virus and trying to gain knowledge over time about what the long-term prognosis is going to be.”

2) Return to work plans must reflect COVID-19’s varied impact on workers

“There is no one size fits all with COVID,” said Bradly.

Tammy Bradly, vice president of clinical product development, Coventry

Young workers who are diagnosed with COVID-19 may experience no symptoms and be back to work in two weeks. Older workers with comorbid conditions may suffer complications that require hospitalization and be out of work for weeks or months.

“Getting a worker back to work is going to vary based on the individual and the severity of the illness,” she said.

“Employers also have to consider many things: whether the workers do an office job and are sedentary, or are they doing manual labor? All those things have to be taken into consideration when we address a return-to-work plan.”

3) Employers Must Be Flexible

With so many potential outcomes, from a person not having any symptoms to possibly being hospitalized for weeks, Howard said employers will have to be flexible about arrangements for how workers return to the workplace.

“Flexibility is going to be key,” he said.

“A lot of people who’ve been diagnosed with this illness have a recovery that’s quite long. They’re very tired and there are lingering aftereffects. I think an employer has to understand and empathize with that.”

He added employers will need to offer different paths back to work, such as allowing a gradual return to work, letting an employee work half the week at home and half in the office, or allowing permanent work from home for some.

4) Communicate Often with Employees

It would not be surprising for a person who’s had COVID-19 to be concerned about possibly becoming re-infected when returning to the workplace.

Unlike other illnesses or injuries, Howard said employers should be aware that coworkers also may have anxieties about working in close proximity to a person who’s had the illness.

To help reduce anxiety, Bradly suggested employers communicate frequently and clearly with all employees.

“Provide them with the latest and most credible information surrounding the virus,” Bradly said. “The Centers for Disease Control website has a section just for employers and bringing employees back to work and how to manage that.”

5) Make the Workplace as Safe as Possible

At a minimum, all employers should be abiding by the CDC guidelines in creating a safe workplace for employees and should also look at their state rules, which, in some cases, may be more strict.

Bradly mentioned that in Pennsylvania, for instance, if an employee tests positive for COVID-19, employers are required to do temperature checks of all employees for two weeks.

“Having that employer show care and concern for all employees and making sure they understand all the things the employer is doing to protect them is going to reduce anxiety, not only the employee who’s coming back with a fear of re-infection, but also for those who’ve been working and have anxiety about being exposed to it.” — Tammy Bradly, vice president of clinical product development, Coventry

Some tips for making a workplace safer include increasing ventilation, if possible, limiting the number of people in the workplace at a time, assigning employees permanent work stations and reducing the use of shared equipment.

6) Listen to Employees and Medical Experts

Howard said employers need to listen to what physicians, other health professionals and the employees themselves have to say about their readiness to return to work, especially when coping with aftereffects of the virus, such as fatigue.

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“It is going to be worse if an employee comes back and is tired and then gets reinjured, especially if their job is physical in nature,” he said.

7) Offer Mental Health Intervention

Bradly noted employers can help ease the anxiety that a person may feel post-COVID by offering mental health services.

“Having that employer show care and concern for all employees and making sure they understand all the things the employer is doing to protect them is going to reduce anxiety, not only the employee who’s coming back with a fear of re-infection, but also for those who’ve been working and have anxiety about being exposed to it,” she said.

8) Case Managers Need to Stay Informed About COVID-19

Howard said case managers need to keep up-to-date on the latest information about the illness from trusted sources such as the CDC and World Health Organization.

Tim Howard, senior vice president of field case management, Genex Services

Case managers can use that information to educate workers about safety in the workplace.

That information also can be tailored to fit a particular workplace.

“At Genex, we have a dedicated guidelines team that takes that information and adapts it to best practices used in workers’ compensation,” Howard explained. “We’re in our ninth revision of our proprietary guideline since the pandemic started.”

Case managers also can help detect and then ease workers’ concerns about getting back to work.

“They’re able to uncover hidden anxiety that might keep a person from going back to work,” Howard said.

9) Using Apps for Health Screening

According to Howard, more employers are using health screening apps before letting workers into the workplace.

He believes such products may be useful for documenting workers’ responses to questions about their own health and for showing that employers are doing what is appropriate to maintain a safe workplace.

“I think it’s a good thing, because, everyone’s concerned about health and safety. But at some point, it’s going to become a legal issue as well,” he said.

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“When those claims start to roll in, relative to who’s responsible legally, the question may be ‘What did you do to make sure that the workplace is safe.’ ”

10) Consider Hiring a Medical Director

Bradly said one of Coventry’s clients recently hired a medical director as a consultant to help them update policies and procedures related to COVID-19 such as how to screen for the illness.

“They’re concerned, because we’re about to hit the flu season. [They want to know] how do they handle, ‘Does this employee have COVID-19 versus the flu?’ ” &

Annemarie Mannion is a freelance writer. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Scenario

The Betrayal of Elizabeth

In this Risk Scenario, Risk & Insurance explores what might happen in the event a telemedicine or similar home health visit violates a patient's privacy. What consequences await when a young girl's tele visit goes viral?
By: | October 12, 2020
Risk Scenarios are created by Risk & Insurance editors along with leading industry partners. The hypothetical, yet realistic stories, showcase emerging risks that can result in significant losses if not properly addressed.

Disclaimer: The events depicted in this scenario are fictitious. Any similarity to any corporation or person, living or dead, is merely coincidental.

PART ONE: CRACKS IN THE FOUNDATION

Elizabeth Cunningham seemingly had it all. The daughter of two well-established professionals — her father was a personal injury attorney, her mother, also an attorney, had her own estate planning practice — she grew up in a house in Maryland horse country with lots of love and the financial security that can iron out at least some of life’s problems.

Tall, good-looking and talented, Elizabeth was moving through her junior year at the University of Pennsylvania in seemingly good order; check that, very good order, by all appearances.

Her pre-med grades were outstanding. Despite the heavy load of her course work, she’d even managed to place in the Penn Relays in the mile, in the spring of her sophomore season, in May of 2019.

But the winter of 2019/2020 brought challenges, challenges that festered below the surface, known only to her and a couple of close friends.

First came betrayal at the hands of her boyfriend, Tom, right around Thanksgiving. She saw a message pop up on his phone from Rebecca, a young woman she thought was their friend. As it turned out, Rebecca and Tom had been intimate together, and both seemed game to do it again.

Reeling, her holiday mood shattered and her relationship with Tom fractured, Elizabeth was beset by deep feelings of anxiety. As the winter gray became more dense and forbidding, the anxiety grew.

Fed up, she broke up with Tom just after Christmas. What looked like a promising start to 2020 now didn’t feel as joyous.

Right around the end of the year, she plucked a copy of her father’s New York Times from the table in his study. A budding physician, her eyes were drawn to a piece about an outbreak of a highly contagious virus in Wuhan, China.

“Sounds dreadful,” she said to herself.

Within three months, anxiety gnawed at Elizabeth daily as she sat cloistered in her family’s house in Bel Air, Maryland.

It didn’t help matters that her brother, Billy, a high school senior and a constant thorn in her side, was cloistered with her.

She felt like she was suffocating.

One night in early May, feeling shutdown and unable to bring herself to tell her parents about her true condition, Elizabeth reached out to her family physician for help.

Dr. Johnson had been Elizabeth’s doctor for a number of years and, being from a small town, Elizabeth had grown up and gone to school with Dr. Johnson’s son Evan. In fact, back in high school, Evan had asked Elizabeth out once. Not interested, Elizabeth had declined Evan’s advances and did not give this a second thought.

Dr. Johnson’s practice had recently been acquired by a Virginia-based hospital system, Medwell, so when Elizabeth called the office, she was first patched through to Medwell’s receptionist/scheduling service. Within 30 minutes, an online Telehealth consult had been arranged for her to speak directly with Dr. Johnson.

Due to the pandemic, Dr. Johnson called from the office in her home. The doctor was kind. She was practiced.

“So can you tell me what’s going on?” she said.

Elizabeth took a deep breath. She tried to fight what was happening. But she could not. Tears started streaming down her face.

“It’s just… It’s just…” she managed to stammer.

The doctor waited patiently. “It’s okay,” she said. “Just take your time.”

Elizabeth took a deep breath. “It’s like I can’t manage my own mind anymore. It’s nonstop. It won’t turn off…”

More tears streamed down her face.

Patiently, with compassion, the doctor walked Elizabeth through what she might be experiencing. The doctor recommended a follow-up with Medwell’s psychology department.

“Okay,” Elizabeth said, some semblance of relief passing through her.

Unbeknownst to Dr. Johnson, her office door had not been completely closed. During the telehealth call, Evan stopped by his mother’s office to ask her a question. Before knocking he overheard Elizabeth talking and decided to listen in.

PART TWO: BETRAYAL

As Elizabeth was finding the courage to open up to Dr. Johnson about her psychological condition, Evan was recording her with his smartphone through a crack in the doorway.

Spurred by who knows what — his attraction to her, his irritation at being rejected, the idleness of the COVID quarantine — it really didn’t matter. Evan posted his recording of Elizabeth to his Instagram feed.

#CantManageMyMind, #CrazyGirl, #HelpMeDoctorImBeautiful is just some of what followed.

Elizabeth and Evan were both well-liked and very well connected on social media. The posts, shares and reactions that followed Evan’s digital betrayal numbered in the hundreds. Each one of them a knife into the already troubled soul of Elizabeth Cunningham.

By noon of the following day, her well-connected father unleashed the dogs of war.

Rand Davis, the risk manager for the Medwell Health System, a 15-hospital health care company based in Alexandria, Virginia was just finishing lunch when he got a call from the company’s general counsel, Emily Vittorio.

“Yes?” Rand said. He and Emily were accustomed to being quick and blunt with each other. They didn’t have time for much else.

“I just picked up a notice of intent to sue from a personal injury attorney in Bel Air, Maryland. It seems his daughter was in a teleconference with one of our docs. She was experiencing anxiety, the daughter that is. The doctor’s son recorded the call and posted it to social media.”

“Great. Thanks, kid,” Rand said.

“His attorneys want to initiate a discovery dialogue on Monday,” Emily said.

It was Thursday. Rand’s dreams of slipping onto his fishing boat over the weekend evaporated, just like that. He closed his eyes and tilted his face up to the heavens.

Wasn’t it enough that he and the other members of the C-suite fought tooth and nail to keep thousands of people safe and treat them during the COVID-crisis?

He’d watched the explosion in the use of telemedicine with a mixture of awe and alarm. On the one hand, they were saving lives. On the other hand, they were opening themselves to exposures under the Health Insurance Portability and Accountability Act. He just knew it.

He and his colleagues tried to do the right thing. But what they were doing, overwhelmed as they were, was simply not enough.

PART THREE: FALLING DOMINOES

Within the space of two weeks, the torture suffered by Elizabeth Cunningham grew into a class action against Medwell.

In addition to the violation of her privacy, the investigation by Mr. Cunningham’s attorneys revealed the following:

Medwell’s telemedicine component, as needed and well-intended as it was, lacked a viable informed consent protocol.

The consultation with Elizabeth, and as it turned out, hundreds of additional patients in Maryland, Pennsylvania and West Virginia, violated telemedicine regulations in all three states.

Numerous practitioners in the system took part in teleconferences with patients in states in which they were not credentialed to provide that service.

Even if Evan hadn’t cracked open Dr. Johnson’s door and surreptitiously recorded her conversation with Elizabeth, the Medwell telehealth system was found to be insecure — yet another violation of HIPAA.

The amount sought in the class action was $100 million. In an era of social inflation, with jury awards that were once unthinkable becoming commonplace, Medwell was standing squarely in the crosshairs of a liability jury decision that was going to devour entire towers of its insurance program.

Adding another layer of certain pain to the equation was that the case would be heard in Baltimore, a jurisdiction where plaintiffs’ attorneys tended to dance out of courtrooms with millions in their pockets.

That fall, Rand sat with his broker on a call with a specialty insurer, talking about renewals of the group’s general liability, cyber and professional liability programs.

“Yeah, we were kind of hoping to keep the increases on all three at less than 25%,” the broker said breezily.

There was a long silence from the underwriters at the other end of the phone.

“To be honest, we’re borderline about being able to offer you any cover at all,” one of the lead underwriters said.

Rand just sat silently and waited for another shoe to drop.

“Well, what can you do?” the broker said, with hope draining from his voice.

The conversation that followed would propel Rand and his broker on the difficult, next to impossible path of trying to find coverage, with general liability underwriters in full retreat, professional liability underwriters looking for double digit increases and cyber underwriters asking very pointed questions about the health system’s risk management.

Elizabeth, a strong young woman with a good support network, would eventually recover from the damage done to her.

Medwell’s relationships with the insurance markets looked like it almost never would. &

Bar-Lessons-Learned---Partner's-Content-V1b

Risk & Insurance® partnered with Allied World to produce this scenario. Below are Allied World’s recommendations on how to prevent the losses presented in the scenario. This perspective is not an editorial opinion of Risk & Insurance.®.

The use of telehealth has exponentially accelerated with the advent of COVID-19. Few health care providers were prepared for this shift. Health care organizations should confirm that Telehealth coverage is included in their Medical Professional, General Liability and Cyber policies, and to what extent. Concerns around Telehealth focus on HIPAA compliance and the internal policies in place to meet the federal and state standards and best practices for privacy and quality care. As states open businesses and the crisis abates, will pre-COVID-19 telehealth policies and regulations once again be enforced?

Risk Management Considerations:

The same ethical and standard of care issues around caring for patients face-to-face in an office apply in telehealth settings:

  • maintain a strong patient-physician relationship;
  • protect patient privacy; and
  • seek the best possible outcome.

Telehealth can create challenges around “informed consent.” It is critical to inform patients of the potential benefits and risks of telehealth (including privacy and security), ensure the use of HIPAA compliant platforms and make sure there is a good level of understanding of the scope of telehealth. Providers must be aware of the regulatory and licensure requirements in the state where the patient is located, as well as those of the state in which they are licensed.

A professional and private environment should be maintained for patient privacy and confidentiality. Best practices must be in place and followed. Medical professionals who engage in telehealth should be fully trained in operating the technology. Patients must also be instructed in its use and provided instructions on what to do if there are technical difficulties.

This case study is for illustrative purposes only and is not intended to be a summary of, and does not in any way vary, the actual coverage available to a policyholder under any insurance policy. Actual coverage for specific claims will be determined by the actual policy language and will be based on the specific facts and circumstances of the claim. Consult your insurance advisors or legal counsel for guidance on your organization’s policies and coverage matters and other issues specific to your organization.

This information is provided as a general overview for agents and brokers. Coverage will be underwritten by an insurance subsidiary of Allied World Assurance Company Holdings, Ltd, a Fairfax company (“Allied World”). Such subsidiaries currently carry an A.M. Best rating of “A” (Excellent), a Moody’s rating of “A3” (Good) and a Standard & Poor’s rating of “A-” (Strong), as applicable. Coverage is offered only through licensed agents and brokers. Actual coverage may vary and is subject to policy language as issued. Coverage may not be available in all jurisdictions. Risk management services are provided or arranged through AWAC Services Company, a member company of Allied World. © 2020 Allied World Assurance Company Holdings, Ltd. All rights reserved.




Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]