2014 Power Broker

Construction

Building Upon Strengths

Craig Graham, CPCU, ARM, CRIS Senior Vice President Alliant Insurance Services, Los Angeles

Craig Graham, CPCU, ARM, CRIS
Senior Vice President
Alliant Insurance Services, Los Angeles

Craig Graham secured an unheard-of deal for a contractor that was building a tunnel underneath a rail yard for a railroad, while simultaneously constructing several high-rise buildings that rested on a platform over the yard, for a real estate developer. An owner-controlled insurance program covered the building project, but it was not economically feasible for Graham to roll the tunneling project into that program, as the railroad’s coverage demands did not give consideration to the world’s “most difficult” New York construction insurance market.

Graham, senior vice president at Alliant Insurance Services, then convinced the OCIP carriers to also participate in a “relatively affordable” contractor-controlled insurance program for the tunnel, by demonstrating how the contractor could enhance safety on both projects, and how claims management could be coordinated.

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“Craig Graham crafted some really creative solutions to the more problematic markets, such as New York State with its challenging labor laws,” said Bill Buchan, vice president, risk management, at Tutor Perini Corp. “Often the coverages can be very expensive and placing them is a challenge, but he’s been very creative structuring a solution to minimize costs and maximize coverages.”

Graham was able to secure a comprehensive OCIP with “very fair pricing” for the Los Angeles Unified School District, by thoroughly explaining the district’s claims and safety services, said Robert Reider, director of risk finance.

Changing the Game

Paul Healy, CPCU National Practice Leader Aon, Boston

Paul Healy, CPCU
National Practice Leader
Aon, Boston

One of Paul Healy’s clients wanted to bid on construction projects on U.S. military bases in Japan, but the bid specifications referenced the Japan Ministry of Finance approved list of surety companies — which didn’t actually exist, making it impossible for non-Japanese companies to bid on the work. Given the U.S. Army Corps of Engineers was the ultimate owner for these projects and a U.S.-based company with a local office in Japan wanted to bid the work, Healy had to get the agency to change the bid specifications.

To accomplish this, Healy, national practice leader, Construction Services Group at Aon, prompted several U.S. surety companies and their industry trade association to lobby for some political pressure on the Corps’ head office in D.C., to prevail upon the agency’s Japan-based representatives to make the bid requirements reasonable. The agency eventually agreed to change the bid specifications to accept surety bonds from companies on the U.S. Treasury list of approved sureties, in addition to the referenced Japan Ministry of Finance list.

“Paul Healy has been very helpful getting us a bond in Japan,” the client said. “He’s also helped us evaluate various prospective joint-venture partners from a financial perspective.”

“Paul Healy is a strong advocate for us,” said Robert Alger, president and chief executive officer of Lane Construction Corp. “He’s been fabulous to work with and really has the clients’ best interests at heart.”

“Paul was very helpful in placing three new, fairly complex surety agreements for us,” another client said.

Collaborative Excellence

Keith Jurss Senior Vice President Willis, Chicago

Keith Jurss
Senior Vice President
Willis, Chicago

Last year, Keith Jurss was hired to help secure a cutting-edge professional liability policy for a Fortune 100 “diversified international family entertainment and media enterprise” that had started to use the integrated project delivery method on its capital improvement projects.

The IPD method, which requires a multiparty contract between the project owner, designer and contractor, incorporates mutual waivers of liability and financial incentives for the parties to work collaboratively to deliver the project on-time and on-budget.

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However, because of select contractual provisions, the corporate professional liability policies of the design and construction team would not respond appropriately, thus requiring a project-specific alternative.

Jurss, senior vice president at Willis, was able to help underwriters understand the contractual incentives built into the program, and to convince them that the IPD team was truly committed to working collaboratively. Jurss then customized the project solution utilizing a variety of coverages from select carriers. The result was a solution that gave the design and construction team protection for rectifying design and construction errors without having to bring suit against each other. The solution also incorporated best-in-class professional liability coverage to protect against potential third-party claims.

“The challenging element of an IPD is the lack of a mature insurance marketplace,” the client said. “Since my organization has a very active creative and design process on some pretty unique projects, we had a short timeline to have something in place by May.”

En Route to Top-Notch Service 

Jamie Pincus, CRIS Vice President Wells Fargo, Washington, D.C.

Jamie Pincus, CRIS
Vice President
Wells Fargo, Washington, D.C.

Jamie Pincus, vice president and account executive commercial at Wells Fargo, goes far beyond the call of duty.

For the Metropolitan Washington Airports Authority — which oversees the Dulles International and Ronald Reagan National airports, the Dulles Toll Road, and Dulles Corridor Metrorail Project in the D.C. area — Pincus helped with the transition of the aviation owner-controlled insurance program and the implementation of a rail OCIP.

On the authority’s projects, Pincus scheduled vendor, contractor and subcontractor information sessions to ensure that “clear, open communication occurs internally and externally.” She has also deployed a Wells Fargo Insurance loss control/safety specialist to ensure protocols are being followed at the authority’s numerous worksites. Pincus and her team provided similar attentive services for the OCIP of the Maryland Transit Administration.

“The scope and size of our projects and the amount of administrative detail is staggering, but Jamie does an excellent job,” a client said. “She’s very adept at coverage analytics and has superior technical abilities.”

For Swire Properties’ Brickell CityCentre construction project in Miami, Pincus advocated for the placement of webcams with 24/7 surveillance and a process to badge contractors for secure worksites. “Jamie Pincus is outstanding — she has been able to put in a very unique insurance program for us and she’s saved us a lot of money,” said David Gross, construction accountant for Swire Properties.

BlueBar

LBR_ResponsiblityLeaderBLUE_logo-175A Family Effort

Wells Fargo’s Jamie Pincus is a firm believer that the best insurance policy is the one that you might never need.

“In the construction industry, it’s not just about the insurance placement, it’s about the people working on the construction site, providing a safe environment and seeing something develop that others will benefit from and there must be a business understanding of what our client is looking to accomplish,” Pincus said.

Pincus is a big believer in voice-to-voice communication with clients.

“Email is efficient but a lot gets lost in electronic delivery,” she said.

Pincus serves as a mentor to young professionals, not just handing down instructions but giving them the tools to do their jobs better.

“I lead by example. There is nothing I like better than digging into a policy to learn about what coverage is provided and researching a client’s exposure to have a complete understanding about their risk,” she said.

“I’ll do this as a mentor on a daily basis to demonstrate good service.”

In her community, Pincus involves her family in her efforts to help the less fortunate. Her eldest daughter recently joined her and other Wells Fargo team members to deliver groceries and prepared meals to 77 families in the Washington, D.C. area.

She brought all three of her daughters along for a more recent project, painting and repairing the house of a family in need.

BlueBar

Expertise in Action

Susan Schwartz, CPCU, ARM Director Aon, St. Louis

Susan Schwartz, CPCU, ARM
Director
Aon, St. Louis

One of Susan Schwartz’s clients partnered with two other contractors for a large construction project, but the disparity between the contractors on how to handle insurance for the newly formed limited liability company was holding up finalizing the contract.

To help get the $70 million project started, Schwartz, a director at Aon, discussed the completed operations extension with underwriters, negotiated more favorable coverage and pricing terms, met with the contractors and their brokers to discuss the insurance program, and worked out an equitable broker compensation solution.

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Schwartz met regularly with another client to discuss estimates for coverage and pricing of a contractor-controlled insurance program at various loss ratio levels, and detailed the merits of project-specific coverage for various lines including professional liability, pollution liability, builders risk and contractor default insurance, potentially saving the client more than $500,000.

“With short notice, Sue was able to work with my company and team leaders from other companies and brokerage firms to develop a comprehensive strategy and risk solution for a complex joint venture project,” said Kathy Norris, director of risk management at Fred Weber Inc. “Her clear view and analysis of situations coupled with her can-do attitude, professionalism, and her willingness and ability to listen to the opinions of others and share ideas make her a valuable resource.”

“Sue Schwartz is by far the most knowledgeable when it comes to construction issues and coverage,” said Monica Settle, insurance risk manager at Western Construction Group.

Powerful Platform

Matthew Walsh Managing Director Aon, Chicago

Matthew Walsh
Managing Director
Aon, Chicago

Matthew Walsh was tasked to respond to a significant uptick in large, complex construction projects undertaken by both private and public sector clients throughout the world.

Walsh, managing director, brokerage practice leader, global/complex clients, Construction Services Group at Aon, built a unique analytics and brokerage platform to address the risks in these complex global projects, including rapidly changing laws impacting construction risk, geographic challenges from catastrophe, and increasingly complex project delivery methods that blur the lines of responsibility between project owners, designers and contractors. It can be used to address various unique legal challenges in some of the world’s most challenging construction liability jurisdictions, or structured for global responsiveness to a single owner undertaking projects simultaneously.

“Matt Walsh goes above and beyond to meet his clients’ needs,” said Ted Wickenhauser, vice president, risk management at McCarthy Building Cos. “He does a phenomenal job at being a client advocate as well as liaison between the markets and his clients. He is never afraid to confront any challenging situation head-on, take ownership of it and move it toward resolution.”

“Matt is very knowledgeable on construction management, as well as the insurance industry,” another client said. “I also think he’s extremely talented from a people skills standpoint, and he’s highly regarded at all levels of the insurance industry.”

BlueBar

LBR_ResponsiblityLeaderBLUE_logo-175A True Team Leader

The global upturn in commercial construction is, on the face of it, good news.

But many of our risk management sources caution that there is great risk in this upturn. Geographic challenges in catastrophe-prone areas and rapid changes in laws governing construction risk are just a few of these factors. Aon’s Matthew Walsh has built a unique analytics and brokerage platform tailored to address the risks of stakeholders in  complex, global undertakings.

Walsh’s base in his 25 years in the business is Chicago, which as a venue ranks as either first or second in construction liability risk from year to year. He feels he’s learned a lot about the business, which is why he is so passionate about passing his knowledge on to a new generation of brokers.

“What has remained constant is that you need a vast team, with vast knowledge and access to vast resources to deliver in these environments,” Walsh said.

“Going it alone was, and never is, an option; it’s all about our team and always will be,” he said.

“At present, I am privileged to have a talented group of young people recruited from our career development program, and young leaders from the construction risk management community, to develop a new generation of construction risk tools delivered through a web portal environment.”

BlackBarFinalists:

Donna Allard-Flett Senior Vice President Aon

Donna Allard-Flett
Senior Vice President
Aon

Gavin Hurd Managing Director Wortham Insurance

Gavin Hurd
Managing Director
Wortham Insurance

Tim McGinnis Senior Vice President Willis

Tim McGinnis
Senior Vice President
Willis

Vincent Zegers Managing Director  Marsh

Vincent Zegers
Managing Director
Marsh

Michael White Senior Managing Director Beecher Carlson

Michael White
Senior Managing Director
Beecher Carlson

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2016 Power Broker

Power Broker Rising Stars

The class of 2016 impresses with its size and quality.
By: and | March 1, 2016 • 3 min read

Judging the talent employed by commercial insurance brokers leads us to one conclusion; optimism is the order of the day.

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As we discovered this year, not only are the ranks of high-achieving younger brokers as strong as ever, they are increasing in number.

We’ve renamed our Power Broker® “Under 40” category to “Rising Stars” to better celebrate this wave of talent and to focus on an important point. Yes, this is a younger group of professionals, all of them under 40, but it’s more on point to think of them as the future leaders of this profession.

As Power Broker® winners and finalists, this set of Rising Stars demonstrated a superior level of creativity in finding solutions for their clients, unflagging customer service and a devotion to learning more about their industry.

Just four years ago, the number of brokers honored by this designation hovered around 40. Last, year, there were 54 Power Broker® winners and finalists recognized in the Under 40 category.

Over the next few pages, you will see the names and affiliations of 77 brokers we recognize as Rising Stars. Since the launch of this category in 2009, more than 250 brokers under 40 received the designation.

The average age of the Rising Stars designees is 36. They represent a powerful wave of talent that is bolstering a profession, which like many other professions will be challenged to replace talent as the baby boomers retire.

For this group of Rising Stars, a career in commercial insurance brokerage is a compelling challenge that results in rich rewards.

“I really enjoy telling ‘the story’ on behalf of my client to the insurance carrier, to pique their interest in an account,” — Ashley De Paola, assistant vice president, Alliant

We first came to know Lockton’s Christopher Keith when he broke into the Power Broker® ranks as a winner in the Workers’ Compensation category in February 2013.

In those days, Keith worked for the Philadelphia-based Graham Co. Keith, 39, said it’s the “entrepreneurial” nature of the business that he finds so rewarding.

“I like the fact that I am managing my own profit and loss statement,” said Keith, who this year achieved Power Broker® status in the Aviation category.

Ashley De Paola, assistant vice president, Alliant

Ashley De Paola, assistant vice president, Alliant

At Lockton’s annual President’s Dinner, he was recognized as the “prototype” Lockton producer.

“I’m very proud of that,” he said.

Alliant’s Ashley De Paola, 33, a 2016 Power Broker® in the Real Estate category, said it’s the quick-paced, evolving atmosphere of commercial insurance brokerage that excites her.

“I really enjoy telling ‘the story’ on behalf of my client to the insurance carrier, to pique their interest in an account,” De Paola said.

Earlier in her career, a client expressed his concern over her age and experience. Her review of his insurance program changed his mind.

“It was very rewarding when he later asked me to work on his business,” she said.

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Beecher Carlson’s Joe Roberta, a 2016 Power Broker® winner in the Private Equity category, has several reasons he likes working in this industry. Top of the list is that this is a very “social industry.”

“I truly enjoy working with people that I’ve been fortunate enough to build long-term relationships with,” he said.

Justin Wiley, 32, Power Broker® winner in the Public Sector category, works for Arthur J. Gallagher & Co., which prides itself on its mentoring efforts.

The company sent Wiley to Orlando, Fla., to work with veteran Rich Terlecki, himself a multiple Power Broker® winner.

“My goal was to learn and gather from him as much intellectual capital as possible,” Wiley said.

Clearly, Terlecki taught him well.

The 2016 Power Broker® Rising Stars

Morgan Anderson, 38 Arthur J. Gallagher Irvine, Calif. Real Estate

Morgan Anderson, 38
Arthur J. Gallagher
Irvine, Calif.
Real Estate

Peter Ballas, 33 Aon Morristown, N.J. At-large

Peter Ballas, 33
Aon
Morristown, N.J.
At-large

Brooke Barnett, 37 Marsh Los Angeles Entertainment

Brooke Barnett, 37
Marsh
Los Angeles
Entertainment

Herman Brito Jr., 26 Marsh New York Marine

Herman Brito Jr., 26
Marsh
New York
Marine

John Byers, 34 Aon Franklin, Tenn. Employee Benefits

John Byers, 34
Aon
Franklin, Tenn.
Employee Benefits

Sandy Carter, 32 Beecher Carlson Atlanta Automotive

Sandy Carter, 32
Beecher Carlson
Atlanta
Automotive

Brandon Cole, 31 Arthur J. Gallagher Irvine, Calif. Nonprofit

Brandon Cole, 31
Arthur J. Gallagher
Irvine, Calif.
Nonprofit

Edward Conlon, 37 Aon New York Financial Institutions

Edward Conlon, 37
Aon
New York
Financial Institutions

Chris Connelly, 32 Arthur J. Gallagher Orlando, Fla. Public Sector

Chris Connelly, 32
Arthur J. Gallagher
Orlando, Fla.
Public Sector

Anne Corona, 38 Aon San Francisco Technology

Anne Corona, 38
Aon
San Francisco
Technology

Cara Cortes, 35 Aon Pittsburgh At-large

Cara Cortes, 35
Aon
Pittsburgh
At-large

Uri Dallal, 37 Aon New York Financial Institutions

Uri Dallal, 37
Aon
New York
Financial Institutions

Ashley De Paola, 33 Alliant New York Real Estate

Ashley De Paola, 33
Alliant
New York
Real Estate

Brian Dougal, 38 Aon San Francisco Real Estate

Brian Dougal, 38
Aon
San Francisco
Real Estate

Justin Dove, 29 Arthur J. Gallagher San Francisco Real Estate

Justin Dove, 29
Arthur J. Gallagher
San Francisco
Real Estate

Patrick Drake, 27 Aon Southfield, Mich. Utilities, Alternative

Patrick Drake, 27
Aon
Southfield, Mich.
Utilities, Alternative

Dan Edelstein, 37 Willis Towers Watson New York Manufacturing

Dan Edelstein, 37
Willis Towers Watson
New York
Manufacturing

Tim Farward, 36 Marsh Philadelphia Utilities, traditional

Tim Farward, 36
Marsh
Philadelphia
Utilities, traditional

Larissa Gallagher, 28 Aon Southfield, Mich. Manufacturing

Larissa Gallagher, 28
Aon
Southfield, Mich.
Manufacturing

Dominic Gallina, 39 Aon New York Real Estate

Dominic Gallina, 39
Aon
New York
Real Estate

Kevin Garvey, 37 Aon Cleveland Automotive

Kevin Garvey, 37
Aon
Cleveland
Automotive

Matthew Giambagno, 26 Marsh, New York Energy/Downstream

Matthew Giambagno, 26
Marsh, New York
Energy/Downstream

Blake Giannisis, 36 Aon New York Real Estate

Blake Giannisis, 36
Aon
New York
Real Estate

George Gionis, 33 Aon Philadelphia At-large

George Gionis, 33
Aon
Philadelphia
At-large

Debbie Goldstine, 39 Lockton Chicago Manufacturing

Debbie Goldstine, 39
Lockton
Chicago
Manufacturing

Sarah Goodman, 36 Marsh New York Pharma/Life Sciences

Sarah Goodman, 36
Marsh
New York
Pharma/Life Sciences

Jessica Govic, 30 Arthur J. Gallagher Itasca, Ill. Public Sector

Jessica Govic, 30
Arthur J. Gallagher
Itasca, Ill.
Public Sector

Robert Hale, 39 Aon London Utilities, traditional

Robert Hale, 39
Aon
London
Utilities, traditional

Joshua Halpern, 34 Aon New York Private Equity

Joshua Halpern, 34
Aon
New York
Private Equity

Matthew Heinz, 39 Aon New York Private Equity

Matthew Heinz, 39
Aon
New York
Private Equity

Charlie Herr, 25 Arthur J. Gallagher Kansas City, Mo. Education

Charlie Herr, 25
Arthur J. Gallagher
Kansas City, Mo.
Education

Blythe Hogan, 31 Aon New York Fine Arts

Blythe Hogan, 31
Aon
New York
Fine Arts

James Jackson, 35 Willis Towers Watson New York Financial Institutions

James Jackson, 35
Willis Towers Watson
New York
Financial Institutions

Sarah Johnson Court, 35 Aon, Miami Fine Arts

Sarah Johnson Court, 35
Aon, Miami
Fine Arts

Christopher Keith, 39 Lockton Blue Bell, Pa. Aviation & Aerospace

Christopher Keith, 39
Lockton
Blue Bell, Pa.
Aviation & Aerospace

Charlie King, 36 Alliant Houston Energy/Upstream

Charlie King, 36
Alliant
Houston
Energy/Upstream

Jonathan Kosin, 37 Aon Southfield, Mich. Construction

Jonathan Kosin, 37
Aon
Southfield, Mich.
Construction

Tyler LaMantia, 29 Arthur J. Gallagher Itasca, Ill. Education

Tyler LaMantia, 29
Arthur J. Gallagher
Itasca, Ill.
Education

Jeanna Madlener, 37 Wells Fargo Portland, Ore. At-large

Jeanna Madlener, 37
Wells Fargo
Portland, Ore.
At-large

 Kimberly Mann, 27 Marsh Philadelphia Environmental


Kimberly Mann, 27
Marsh
Philadelphia
Environmental

Kristina Marcigliano, 27 DeWitt Stern New York Fine Arts

Kristina Marcigliano, 27
DeWitt Stern
New York
Fine Arts

 Matt Medeiros, 34 Arthur J. Gallagher Media, Pa. Retail


Matt Medeiros, 34
Arthur J. Gallagher
Media, Pa.
Retail

Mary Mulhern, 33 Marsh Chicago Health Care

Mary Mulhern, 33
Marsh
Chicago
Health Care

Dennis Nevinski, 31 Aon Chicago Aviation & Aerospace

Dennis Nevinski, 31
Aon
Chicago
Aviation & Aerospace

Lee Newmark, 28 Arthur J. Gallagher Itasca, Ill. Health Care

Lee Newmark, 28
Arthur J. Gallagher
Itasca, Ill.
Health Care

Jake Onken, 26 Aon Houston Health Care

Jake Onken, 26
Aon
Houston
Health Care

Joanna Paredes, 28 Rekerdres & Sons Dallas Marine

Joanna Paredes, 28
Rekerdres & Sons
Dallas
Marine

Stephen Pasdiora, 27 Cottingham & Butler Rosemont, Ill. Employee Benefits

Stephen Pasdiora, 27
Cottingham & Butler
Rosemont, Ill.
Employee Benefits

Stefanie Pearl, 35 Marsh New York Financial Institutions

Stefanie Pearl, 35
Marsh
New York
Financial Institutions

Jason Peery, 37 Aon Newport Beach, Calif. Real Estate

Jason Peery, 37
Aon
Newport Beach, Calif.
Real Estate

Adrian Pellen, 32 Aon Chicago Construction

Adrian Pellen, 32
Aon
Chicago
Construction

Chris Rafferty, 36 Aon Chicago Manufacturing

Chris Rafferty, 36
Aon
Chicago
Manufacturing

Daniel R’bibo, 36 Arthur J. Gallagher Glendale, Calif. Entertainment

Daniel R’bibo, 36
Arthur J. Gallagher
Glendale, Calif.
Entertainment

Brent Rieth, 30 Aon San Francisco Technology

Brent Rieth, 30
Aon
San Francisco
Technology

 Joe Roberta, 35 Beecher Carlson New York Private Equity


Joe Roberta, 35
Beecher Carlson
New York
Private Equity

Robert Rosenzweig, 30 Risk Strategies New York Technology

Robert Rosenzweig, 30
Risk Strategies
New York
Technology

 Patrick Roth, 35 Aon Denver Pharma/Life Sciences


Patrick Roth, 35
Aon
Denver
Pharma/Life Sciences

 Laura Rubin, 33 Beecher Carlson Boston Utilities, Alternative


Laura Rubin, 33
Beecher Carlson
Boston
Utilities, Alternative

 Ian Schwartz,31 Aon Los Angeles Real Estate


Ian Schwartz,31
Aon
Los Angeles
Real Estate

Christopher Shorter, 36 Aon Houston Energy/Downstream

Christopher Shorter, 36
Aon
Houston
Energy/Downstream

Brian Simons, 34 Aon New York Financial Institutions

Brian Simons, 34
Aon
New York
Financial Institutions

Andrew Smith, 28 Marsh New York Marine

Andrew Smith, 28
Marsh
New York
Marine

Timothy Sullivan, 38 Willis Towers Watson Boston Financial Institutions

Timothy Sullivan, 38
Willis Towers Watson
Boston
Financial Institutions

Kurt Thoennessen, 37 Ericson Ins. Advisors Washington Depot, Conn. Private Client

Kurt Thoennessen, 37
Ericson Ins. Advisors
Washington Depot, Conn.
Private Client

 John Tomlinson, 37 Lockton Encino, Calif. Entertainment


John Tomlinson, 37
Lockton
Encino, Calif.
Entertainment

 Kaitlin Upchurch, 30 Wortham Houston At-large


Kaitlin Upchurch, 30
Wortham
Houston
At-large

 Liz Van Dervort, 30 Gillis, Ellis & Baker New Orleans Nonprofit


Liz Van Dervort, 30
Gillis, Ellis & Baker
New Orleans
Nonprofit

 Rene Van Winden, 36 Aon Houston Energy/Downstream


Rene Van Winden, 36
Aon
Houston
Energy/Downstream

Ben Von Obstfelder, 30 Aon Wauconda, Ill. Retail

Ben Von Obstfelder, 30
Aon
Wauconda, Ill.
Retail

Michael Walsh, 35 Marsh Boston Real Estate

Michael Walsh, 35
Marsh
Boston
Real Estate

Emily Weiss, 29 DeWitt Stern New York Fine Arts

Emily Weiss, 29
DeWitt Stern
New York
Fine Arts

Jeremiah White, 38 Aon Frederick, Md. Transportation

Jeremiah White, 38
Aon
Frederick, Md.
Transportation

 Joshua White, 28 Gulfshore Insurance Naples, Fla. Private Client


Joshua White, 28
Gulfshore Insurance
Naples, Fla.
Private Client

Casey Wigglesworth, 37 Aon Washington, DC Fine Arts

Casey Wigglesworth, 37
Aon
Washington, DC
Fine Arts

 Justin Wiley, 33 Arthur J. Gallagher Orlando, Fla. Public Sector


Justin Wiley, 33
Arthur J. Gallagher
Orlando, Fla.
Public Sector

Wendy Wu, 38 Aon Shanghai Automotive

Wendy Wu, 38
Aon
Shanghai
Automotive

Susan Young, 30 Marsh Seattle Retail

Susan Young, 30
Marsh
Seattle
Retail

Dan Reynolds is editor-in-chief of Risk & Insurance®. He can be reached at [email protected] Tom Starner, a freelance journalist, can be reached at [email protected]
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Sponsored Content by CorVel

Advocacy: The Impact of Continuous Triage

Claims management is never stagnant. Utilizing a continuous triage model keeps injured employees on track to recovery.
By: | May 4, 2016 • 6 min read

SponsoredContent_CorVel

Introduction

In the world of workers’ compensation, timing is everything. Many studies have shown that the earlier a workplace incident or injury is acted upon, the more successful the results*. However, there is further evidence indicating there is even more of an impact seen when a claim is not only filed promptly, but also effective triage is conducted and management of the claim takes place consistently through closure.

Typically, every program incorporates a form of early intervention. But then what? While it is common knowledge that early claims reporting and medical treatment are the most critical parts of a claim, if left alone after management, an injured worker could – and often does – fall through the cracks.

All Claims Paths are Not Created Equal

Even with early intervention and the best intentions of the adjuster, things can still go wrong. What if we could follow one injury down two paths, resulting in two entirely different outcomes? This case study illustrates the difference between two claims management processes – one of proactive, continuous claims triage and one of inactivity after initial intervention – and the impact, or lack thereof, it can have on the outcome of a claim. By addressing all indicators, effective triage can drastically change the trajectory of a claim.

The Injury

While working at a factory, David, a 40-year-old employee, experienced sudden shoulder pain while lifting a heavy box. He reported the incident to his supervisor, who contacted their 24/7 triage call center to report the incident. After speaking with a triage nurse, the nurse recommended he go to an occupational medicine clinic for further evaluation, based on his self-reported symptoms of significant swelling, a lack of range of motion and a pain level described as greater than “8.”

The physician diagnosed David with a shoulder sprain and prescribed two weeks of rest, ice and prescription strength ibuprofen. He restricted David from any lifting over his head.

By all accounts, early intervention was working. Utilizing 24/7 nurse triage, there was no lag time between the incident and care. David received timely medical attention and had a treatment plan in place within one day.

But Wait…

A critical factor in any program is a return to work date, yet David was not given a return to work date from the physician at the occupational medicine clinic; therefore, no date was entered in the system.

One small, crucial detail needs just as much attention as when an incident is initially reported. What happens the third week of a claim is just as important as what happens on the day the injury occurs. Involvement with a claim must take place through claim closure and not just at initial triage.

The Same Old Story

After three weeks of physical therapy, no further medical interventions and a lack of communication from his adjuster, David returned to his physician complaining of continued pain. The physician encouraged him to continue physical therapy to improve his mobility and added an opioid prescription to help with his pain.

At home, with no return to work in sight, David became depressed and continued to experience pain in his shoulder. He scheduled an appointment with the physician months later, stating physical therapy was not helping. Since David’s pain had not subsided, the physician ordered an MRI, which came back negative, and wrote David a prescription for medication to manage his depression. The physician referred him to an orthopedic specialist and wrote him a new prescription for additional opioids to address his pain…

Costly medical interventions continued to accrue for the employer and the surmounting risk of the claim continued to go unmanaged. His claim was much more severe than anyone knew.

What if his injury had been managed?

A Model Example

Using a claims system that incorporated a predictive modeling rules engine, the adjuster was immediately prompted to retrieve a return to work date from the physician. Therefore, David’s file was flagged and submitted for a further level of nurse triage intervention and validation. A nurse contacted the physician and verified that there was no return to work date listed on the medical file because the physician’s initial assessment restricted David to no lifting.

As a result of these triage validations, further interventions were needed and a telephonic case manager was assigned to help coordinate care and pursue a proactive return to work plan. Working with the physical therapist and treating physician resulted in a change in David’s medication and a modified physical therapy regimen.

After a few weeks, David reported an improvement in his mobility and his pain level was a “3,” thus prompting the case manager’s request for a re-evaluation. After his assessment, the physician lifted the restriction, allowing David to lift 10 pounds overhead. With this revision, David was able to return to work at modified duty right away. Within six weeks he returned to full duty.

With access to all of the David’s data and a rules engine to keep adjusters on top of the claim, the medical interventions that were needed for his recovery were validated, therefore effectively managing his recovery by continuing to triage his claim. By coordinating care plans with the physician and the physical therapist, and involving a case manager early on, the active management of David’s claim enabled him to remain engaged in his recovery. There was no lapse in communication, treatment or activity.

CorVel’s Model

After 24/7 nurse triage is conducted and an injured worker receives initial care, CorVel’s claims system, CareMC, conducts continuous triage of all data points collected at claim inception and throughout the life of a claim utilizing its integrated rules engine. Predictive indicators send alerts to prompt the adjuster to take action when needed until the claim is closed ­– not just at the beginning of the claim.

This predictive modeling tool flags potentially complex claims with the risk for high exposure, marking claims that need intervention so that CorVel can assign appropriate resources to mitigate risk.

Claims triage is constant – that is the necessary model. Even on an adjuster’s best day, humans aren’t perfect. A rules engine helps flag things that people can miss. A combination of predictive systems and human intervention ensures claims management is never stagnant – that there is no lapse in communication, activity or treatment. With an advocacy team in the form of an adjuster empowered by a powerful rules engine and a case manager looking out for the best care, injured employees remain engaged in their recovery. By perpetuating patient advocacy, continuous triage reduces claim severity and improves claim outcomes, returning injured workers to the workforce and reducing payors’ risk.

*WCRI.

This article was produced by CorVel Corporation and not the Risk & Insurance® editorial team.



CorVel is a national provider of risk management solutions for employers, third party administrators, insurance companies and government agencies seeking to control costs and promote positive outcomes.
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