Roberto Ceniceros

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

Column: Workers' Comp

The Engagement Factor

By: | August 31, 2015 • 3 min read
Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

Employers face a crisis with recent studies showing that worker disengagement has reached 70 percent.

Fortunately, I’m an engaged worker, according to a predictive tool that helps employers learn more about job recruits and existing employees by measuring their “sense of good judgment” in more than 70 areas.

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I learned of the predictive tool called the Judgment Index while reporting on integrated disability management. Renee Mattaliano, VP and practice lead of workforce management at HUB International, told me how employers can apply the index to learn whether a certain job will engage a specific job recruit.

The more engaged a worker, the less likely they are to be injured. The more engaged, the sooner they will return to the job should they suffer an injury.

That’s valuable insight for an employer.

Predictive information about how people will behave is being applied across more areas. A non-traditional loan company, for example, now uses a judgment tool to lend money to recent college grads lacking credit histories.

That tool evaluates grade point averages, SAT scores and colleges attended, among other data. It then determines the value credit applicants will place on their obligation to repay debt.

“Who you are is going to drive what you do.” — Roger D. Wall, chief marketing officer, The Judgment Index

Such technology is opening up a world where employers and others will know much more about us, including what we value.

“Who you are is going to drive what you do,” said Roger D. Wall, chief marketing officer for the Judgment Index.

Interest in how worker engagement might be measured and its influence on disability management led me to accept an offer to learn firsthand how the Judgment Index works. That involved having to prioritize several, sometimes odd-seeming, statements according to how much I agreed with them.

From the lengthy results report, I learned that managing difficult people is not one of my strengths. No surprise there.

But I am very strong on absorbing information, processing it and solving problems. I’m an engaged employee, according to the index results, because I value work and have a high degree of reliability. I also am process- or task-oriented.

The outcome also showed I rank strongly for self-care by paying attention to my physical, mental and emotional health. Obviously, the index didn’t ask how many needless calories I nervously consume at my desk while writing.

Still, information about my attitude toward my overall health could prove valuable to an employer customizing a wellness program or building a return-to-work strategy for my specific needs.

It can provide a lot of information about how you might behave under certain circumstances, as well as advice when improvement or caution may be necessary.

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For example, the Judgment Index showed I am “moderately idealistic.” I might be good at helping team members see new possibilities for improving things, but I must make sure my ideas are backed by convincing evidence so people with a strong realist bent don’t write me off as naive.

No wonder I’m engaged by my work. The job allows the moderately idealistic in me to write about how the workplace might be made better.

Now, what to do about the 70 percent who don’t value their work as much as I?

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Integrated Disability Management

Integrated Programs Pay Off When Employees Come First

Obtaining the best results from integrated disability programs requires making the injured or disabled worker the top priority.
By: | August 28, 2015 • 3 min read
Architects in wheelchairs discussing data before meeting with project engineers

Employers that place equal importance on managing all disability claims — regardless of whether their cause is occupational or non-occupational — experience better return-to-work outcomes, said a senior workers’ compensation manager who evaluated practices at nine companies.

Yet she has often heard employers that fully insure their long term disability claims say they don’t pay equal attention to those claims as they do when disabilities are work-related, said Catherine Duhigg Gannon, senior manager of workers’ comp at Eaton, a company with about 100,000 employees including 37,000 across North America.

Such thinking hurts employee relations and diminishes all return to work efforts.

“Focus on disability and return to work should not cease when the perceived cost to the employer decreases,” Duhigg Gannon said. “By that I mean long-term disability plans that were insured and had no [employer] oversight oftentimes resulted in the employee not returning to work. It was amazing how many people basically said, ‘We are not paying for it, so we stopped caring.’ ”

Duhigg Gannon presented her comments as part of a panel that addressed program integration during the recently concluded Worker’s Compensation Institute’s annual conference. She evaluated the practices at nine companies as part of a strategic assessment conducted every five years to help set the future path for her own company’s workers’ comp and disability management efforts.

Care of employees should be the first priority of integrated programs, said Chris Mandel, senior VP strategic solutions at Sedgwick Claims Management Services.

Integrated programs focus on combining the oversight of claims that are often separately managed by corporate risk management or benefits management domains. The claims can include those generated under the Family Medical Leave Act administration, short-term disability, long-term disability or workers’ comp.

“It was amazing how many people basically said, ‘We are not paying for it, so we stopped caring.’ ” — Catherine Duhigg Gannon, senior manager of workers’ comp, Eaton

“Employee care needs to be the first priority,” Mandel said. “We are after outcomes that benefit the employee most.”

The benefits of integration include aligned communications, a single contact for the intake of claims, better handling of data, and improved coordination of specialty case management that supports all causes of work absences, he said.

Other advantages include unified return-to-work planning, unified case management, and the improved communication of benefits, Mandel continued.

“But again, all of that for the benefit of helping employees navigate what could be rather bureaucratic and complex processes that often don’t touch each other, let alone talk and communicate effectively together,” he added.

Eaton has an “integrated disability platform” with the third party administrator handling workers’ comp, STD and LTD claims among others, Duhigg Gannon said. That helps provide continuity in the way the company views all disability claims.

Internally, however, Eaton’s insurance and risk management department oversees workers’ comp while the benefits department manages STD and LTD claims.

A recommendation has been made to Eaton’s senior management that a single, internal department managing all disabilities would be more effective.

“The best return to work outcomes were demonstrated when programs treated all disability claims the same, occupational versus non occupational and efforts to return an employee to gainful employment was equally invested in all disability claims,” Duhigg Gannon’s assessment found.

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.
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WC Cost Control

Injury Report Lag Time Remains a Challenge

A recent study published by NCCI serves as a stern reminder of the link between accident report lag time and higher workers' comp claims costs.
By: | August 19, 2015 • 4 min read
House of Dolar. fire

Workers’ compensation insurers can’t throw their resources into managing a workplace injury until they know about it.

When they eventually learn of an injury after policyholder delays in reporting it to them, the golden hour for providing optimal medical care and facilitating an ideal return-to-work scenario may be lost.

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Research results released earlier this summer by NCCI Holdings Inc. document the extent of such losses. The findings confirm the commonly-held knowledge among worker’s comp practitioners that delays in delivering appropriate medical care and applying claims-resolution best practices often drive additional, unnecessary costs.

NCCI reviewed claims data from 44 states before reaching the conclusions contained in its research brief titled “The Relationship Between Accident Report Lag and Claim Cost in Workers Compensation Insurance.” It found that the median cost of claims was lowest for injuries reported to insurers after the day when an accident occurs, but within two weeks of the incident.

Claims reported during the third week following an injury experienced cost increases that were 35 percent higher relative to those reported during week two. For those reported during week four, the median cost rises another 12 percent. It drops a bit for claims reported after week four although costs remain greater than those reported during the first two weeks.

Claims reported to insurers on the same day as an injury occurs, however, experience costs that are 25 percent more than those reported during week one.

“Claims reported on the day of injury likely include very severe injuries that require immediate medical attention,” NCCI’s research brief states. “Such claims often require extensive medical care and an extended recovery time away from work.”

“Really, it’s communication, and the sooner that communication can begin the sooner we as claims people can do our jobs.” — Glen Pitruzzello, VP of workers comp and group benefits claim practices, The Hartford

Several factors drive additional costs when claims are not promptly reported to insurers, sources said.

An injured worker may seek help from a primary, internal-medicine physician or family doctor who may not understand occupational exposures, said Adam L. Seidner, M.D., and global medical director at Travelers.

The doctor may excel at treating family ailments, yet may not be well acquainted with proven occupational-medicine practices, such as applying a sports medicine approach for treating musculoskeletal injuries.

In contrast, claims adjusters and nurse case managers can assist a worker whose injury is promptly reported to an insurer. They can help him, for example, receive treatment from an orthopedic specialist capable of providing the greatest care possible for their specific condition, Seidner said.

The risk of recidivism also increases when the injured worker doesn’t receive appropriate care, he added. They may return to the job too soon, risking reinjuring themselves.

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“Then we have to put them back in the system with the right people (providing treatment) and the medical costs really increase because we are trying to get things done correctly,” Seidner said. Medical expenses in such cases can increase 100 percent.

Seidner will speak at the National Workers’ Compensation and Disability Conference & Expo scheduled for November 11-13 at Mandalay Bay in Las Vegas.

WCWCHe will be joined by Marcos Iglesias M.D., VP and medical director at The Hartford along with Mel Belsky M.D. and medical director, workers’ comp program, for Safeway Inc. They will present a breakout session titled “The Workers’ Comp Doctor’s Prescription for Medical Intervention.”

They will discuss how opportunities to manage injuries to their optimal conclusions evaporate when claim handlers ignore medical intervention’s power. Denise Algire, director managed care & disability, corporate risk at Safeway Inc. will moderate the session.

Involvement of attorneys becomes more common as the report lag increases. Claims reported immediately involve an attorney 13 percent of the time. This increases to 32 percent for claims reported after Week 4. Source: NCCI 2015

Involvement of attorneys becomes more common as the report lag increases. Claims reported immediately involve an attorney 13 percent of the time. This increases to 32 percent for claims reported after Week 4. Source: NCCI 2015

Meanwhile, the NCCI research brief also documents that as report lag increases attorney involvement grows with 13 percent attorney participation in claims reported immediately. That jumps to 32 percent when insurers receive notification after week four.

“This suggests that the complexity of resolving a claim increases as the report lag increases,” the NCCI paper states.

Glen Pitruzzello, VP of workers comp and group benefits claim practices at The Hartford agrees that medical outcomes improve with earlier reporting of a claim.

The insurer can help the claimant navigate the medical system, connecting them with nurse case managers when necessary, and facilitating communication with the treating doctor, he explained.

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On the indemnity side, insurers can also help by explaining the benefit process to injured workers and help the employer to develop a return-to-work plan, Pitruzzello said.

“Really, it’s communication and the sooner that communication can begin the sooner we as claims people can do our jobs,” Pitruzzellos said. “Part of it is facilitating payment of necessary medical care and facilitating return to work.”

Indeed, NCCI’s findings suggest that when insurers don’t receive notice of injuries, the related claims become more complex to settle and they involve a longer period before the injured worker can return to the job.

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.
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