Adjuster X

Trade Show Flip-Flop

A failed attempt at flattery results in injury. There’s a lot to be said for learning how to take “no” for an answer.
By: | June 1, 2015 • 3 min read

I received an incident report about a meeting planner who had sustained neck and back injuries while attending a trade show. It seemed she had been picked up, hoisted in the air, shaken and placed back on the ground. Not your typical claim.

I spoke with the insured’s marketing director. He explained that one of their male sales managers invited the petite meeting planner to the stage during the trade show. After thanking her for an outstanding job and calling her a “star,” he picked her up, twirled her in the air over his head, and then quickly put her back on the ground. She complained of back and neck pain immediately afterward.

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The thoughtless manager was fired and the planner remained out of work. The director felt the injury wasn’t compensable since it didn’t occur on their premises and it was the result of “fooling around.” The workers’ comp report, he said, was simply procedural. The company had submitted a short-term disability claim.

An ISO search request came back noting two prior injuries: a left arm fracture after falling on an icy mall parking lot and a cervical strain after an auto accident.

I called the meeting planner, Sheila Wilmot, but no one picked up. I was already running out of time to make my first indemnity payment, so I tried to call the manager who hoisted her at the trade show but he refused to cooperate.

Fortunately, since it happened at a trade show, there were plenty of other witnesses.

The three co-workers I spoke with were pretty consistent with what they reported. However, one of them mentioned, off the record, that the sales manager was rumored to have tried to date the meeting planner but was rebuffed. His impression was that the sales manager attempted flattery by bringing the planner to the stage but then got carried away.

The director felt the injury wasn’t compensable since it didn’t occur on their premises and it was the result of “fooling around.” The workers’ comp report, he said, was simply procedural.

Based on the customer’s request, I didn’t initiate compensation benefits. A few months later I received an attorney representation letter, a formal claim hearing request and medical bills totaling $30,000. I called Sheila Wilmot’s attorney and requested permission to speak with her but the lawyer denied that request.

Before requesting a conciliation meeting, I spoke with defense counsel, who felt that the causal relationship was pretty solid. After all, the employee coordinated the trade show for the insured, attended it and sustained the injury in the course of her employment. Incidents resulting from horseplay had successful statutory precedent cases. The potential for an unfair claim practice act litigation also existed.

At the conciliation meeting, Sheila’s attorney said she had a vertebral fracture, cervical strain and a stress condition. Her short-term disability claim was denied. Her doctor indicated the injury was work related. By now, the lost time was 10 weeks with medical bills totaling $30,000.

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We were permitted to schedule an exam, which confirmed the diagnosis. The examiner felt the pre-existing cervical condition was aggravated by the trauma. Sheila was on a physical therapy regimen, taking very high doses of narcotic analgesic pain medications. With the insured’s concurrence, the claim was settled.

So Sheila suffered, her employer paid the consequences, and the sales manager lost his job. There’s a lot to be said for learning how to take “no” for an answer.

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]

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]