Adjuster X

Wild Kingdom

By: | November 3, 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]

One of our clients had a delivery driver involved in a car crash. I happened to be in the area so I was dispatched to the scene. I spoke with an officer after the ambulance left with the driver. The officer checked his notes: “One vehicle accident. Good weather conditions. No skid marks indicating a high rate of speed. Driver says he simply lost control of the van and ran off the road.”

I inspected the van, which had crashed into a copse of trees. The windshield was broken, the front bumper was dented, the headlights were broken, and the grill was damaged.

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I checked the back. The storage area of the van was open to the front seats. It was scattered with boxes that looked more bashed up than I would have expected. “What do you make of that?” I asked the officer.

He shrugged. “Got jostled in the crash?”

The boxes were all fairly light. Some of them looked punctured, but I didn’t spot any sharp objects in the back of the van. I noticed the interior paint in the van was scratched up, too. Odd.

Then I spotted a small smear of blood near the back door of the van. Something really wasn’t adding up here.

At the ER, I introduced myself to the injured driver, Kyle Warner, as a nurse checked his wound, which was on the back of his head, behind the right ear.

After a few preliminary questions, I said: “So, Kyle, what exactly caused the accident to the best of your recollection?”

Warner looked down at the floor and said, “I guess I just lost control of the van.”

“That’s a bit strange,” I replied. “It was a straight road. No lights, stop signs, or construction crews around.” Warner glanced at me sideways. “It’s even more baffling how you sustained a laceration on the back right side of your head.”

He looked uncomfortable. “Maybe a box hit me. I don’t know.”

Then I spotted a small smear of blood near the back door of the van. Something really wasn’t adding up here.

I looked intensely at him. “I think you do, Kyle. What did you have that was alive in the back of that van?”

Warner stammered, “I … I don’t know what you mean.”

“C’mon, what was it?” I pressed. “It was something large. Not a dog. It was wounded. My best guess is a white-tailed deer. The hooves would explain the punctured boxes and the scratched paint, not to mention your head wound.”

Warner was staring at me with his mouth open. “You may as well tell me,” I said. “I can easily get a blood sample from the van.”

“OK,” he said finally, letting out a sigh. “I came across a doe on the side of the road that must’ve been hit by a car. I thought it was dead, so I put it in the van so a friend of mine could butcher it for venison.

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“Only it wasn’t dead — it was just stunned. Five or six miles later, it came to and went berserk in the back of the van. Before I could pull over, it hit me in the head with a hoof and knocked me half senseless. That’s when I ran the van off the road. I was able to get out and get around to the back of the van and let the deer out before the police arrived.”

I indicated that picking up a stunned deer was certainly not something in the course and scope of employment of his job as a driver, and that this non-sanctioned action led directly to his injury.

“What’s going to happen with my job?” Warner asked me.

“That’s up to your employer, Kyle,” I replied. “but I wouldn’t be counting on receiving a commendation.”

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]