BY Sarah Tayts, AIC, ARM, Return to Wellness Specialist for Eastern Alliance Insurance Group
In the mid-90s, Volkswagen North America commercials declared, “On the road of life, there are passengers and there are drivers.” These mutually exclusive identities paint an image of someone grabbing the bull by the horns, seizing the day and taking control of the situation. That’s great, unless you’re in a car where everyone thinks they’re the driver. Knowing when to drive and when to be the navigator is an important skill in life, but also in handling workers’ compensation claims. Of course, being the navigator requires that you relinquish some of your control to the driver. That can be a scary thought.
We need to do more navigating than driving
The average injured worker knows very little about workers’ compensation, other than what they’ve heard on television commercials or the stories of their neighbor’s cousin had a work injury and got a huge settlement. It’s not their civic duty to know this stuff, nor is something most people want to learn, until they or someone they love are injured at work. Knowledge is power. When you feel you are a novice and someone else is an expert, the perceived power distribution follows: you know little, therefore you have little control. Why do you think buying a car is so stressful? Probably because you’re afraid you’re getting ripped off and it impacts your finances for years to come. Not to mention those horrible box diagrams and having to watch the Sales Representative scurry between their desk and the Sales Manager’s office. You sit there, helpless in an uncomfortable chair, wondering if they’re even talking numbers or just killing time because they knew their bottom line since the time you rolled onto the lot.
Layer this uneven distribution of knowledge with ubiquitous disability attorney commercials, uncertainty about the future, and the result is a negative set of expectations before the claim representative even picks up the phone to make their initial contact.
As much as we’d like to think we can control what happens in a workers’ compensation claim, it’s somewhat frightening to consider how little we can control. We can put processes and procedures in place, but at the end of the day all we can do is influence the outcome of a claim. How, when and where we choose to exert our influence depends on the intricacies of each individual claim.
Objective and timely information can go a long way. Explain the benefits and claim process to an injured worker at the outset. Provide the injured worker with all of the information they need to make an educated decision.
When you receive a modified duty release, I suggest you involve the injured worker in return to work discussions. They are, after all, the one who is going to decide if they can perform the work being offered and ultimately if they are going to return to work. They will also weigh the consequences of not returning to work – so make sure they know the impact this will have on their claim.
Preventative maintenance is worth the investment
Effective communication can resolve almost any problem. Poor communication can create an insurmountable list of problems. The majority of workers’ compensation state forms are confusing and illogical. Go figure. In Pennsylvania there is a Notice of Ability to Return to Work form that is sent with a copy of updated work capabilities. I used to receive countless calls from injured workers in a panic that their employer didn’t have work within their restrictions and didn’t understand how we can make them go back to work. The form is simply used to communicate a change in work capabilities to the injured worker and the employer. If you’ve been handling claims for a year or two, you know what forms are going to spur an angry phone call. Why not explain the form prior to sending it out? While it is unrealistic to make the call every time you send a potentially confusing form to an injured worker, set a reasonable expectation at each follow up call about what will happen between now and the next time you speak.
Not everyone is out to take you for a ride
We’re not dealing with claimants. We’re not dealing with plaintiffs. We’re dealing with people who have sustained a disabling event. Maybe they weren’t financially set before the injury, and a twenty-one day compensability determination period is really throwing a wrench into things. Maybe their boss reacted poorly to their report of an injury.
I know what you’re thinking. She’s gone soft. She’s been out of claims too long. Maybe I have, or maybe I’ve been away from a case load long enough. What I do know is that we, as insurance professionals, are experts at what we do. Injured workers are experts at what they do – not workers’ compensation claims. Each injured worker is just that, an individual who was working and sustained an injury. Maybe it’s time we learn when to hand over the keys and act as the navigator.
That’s not to say if the driver runs a red light or breaks the speed limit that we don’t revoke the driving privileges…
About Sarah Tayts
Sarah Tayts is the Return to Wellness Specialist for Eastern Alliance Insurance Group (EAIG) and oversees the company’s ecovery® program. As a RTW Specialist, Sarah works directly with EAIG clients, team members and agency partners to find effective and productive modified duty solutions. She also maintains the ecovery® blog, conducts webinars and uses other social media outlets to educate stakeholders on RTW best practices and benefits of RTW programs.
She graduated from Millersville University in Millersville, Pennsylvania with a Bachelor of Arts degree in Psychology and from the Chicago School of Professional Psychology with a Master of Arts degree in Industrial/Organizational Psychology with a concentration in Organizational Effectiveness. She has also earned the Associate in Claims and the Associate in Risk Management designations.
About Eastern Alliance Insurance Group
Founded in 1997, Eastern Alliance Insurance Group (EAIG) is a specialty underwriter of workers’ compensation products and services for businesses and organizations in the Mid-Atlantic, Southeast, Midwest and Gulf South regions of the United States. EAIG’s ecovery® is an exclusive program that helps return injured workers to wellness and productivity by using work as a therapeutic tool. EAIG has offices in Lancaster and Wexford, Pennsylvania; Charlotte, North Carolina; Carmel, Indiana; Franklin, Tennessee; Richmond, Virginia; and, Madison, Mississippi. EAIG’s Web address is www.eains.com.