By PETER ROUSMANIERE, an expert on the workers' compensation industry
Place an early call to the injured worker. That's a claims commandment that is Mt. Sinai high. It is virtually impossible to find anyone today in workers' compensation who says that claims personnel should not call the injured workers at the earliest chance. Fine, but what is that call meant to achieve?
Three seasoned professionals--a claims executive, a managed-care advisor and the director of a claims unit within a large self-insured employer--weigh in on their preferred scenario for the all-important first call.
According to John Marr, senior vice president of the Portland, Maine-headquartered Maine Employers Mutual Insurance Co., the first call should happen quickly. It should not be held up to collect the initial report from the doctor or an in-depth accident report from the employer.
"An injured worker, more often than not, is lost when a loss occurs and is looking for the helping hand. If you are not the one offering the helping hand, you've lost the chance to establish the pivotal relationship," he said.
For Patrick Venditti, director of corporate health services for BJC HealthCare, a large St. Louis-based hospital system, nurses tend not to be as proactive enough. He has his adjusters (called senior case coordinators) place the call as soon as possible.
Marr is not concerned about who places the call. It's more important to show concern for the injured worker.
"I start by asking how they are now, if they are getting the care that they need and what they need from me. After I find out about them, I can develop the facts of the claim," Marr explained.
Venditti agrees that building rapport with the worker is the single most important goal. Then the caller should ask questions to help complete "the total picture of the incident" and help establish compensability.
"The caller should guide and answer the employee's questions to make them feel more at ease with the process and the expectations," Venditti said.
THE DUAL MESSAGE
Jennifer Christian, an occupational medicine physician and president of the Wayland, Mass.-based consultancy Webility Corp., suggests a nuanced approach after having studied and listened in on some actual first calls.
She says the caller must convey from the outset a dual message. One message is that the claims staff intends to help the worker.
"We (the claims staff) have expertise in these matters and want to be a resource for her, that she is not being left alone to fend for herself, and we will do our best to help this all turn out all right," Christian explained.
The second message is: "We are going to keep track of this episode."
"It is going to be actively observed and managed because we are not suckers, and she will not be left alone in the shadows to take advantage of us," Christian said.
By the time the initial call happens, a lot of missteps could have occurred between an ignorant and na´ve worker and her supervisor, Christian noted. Most people have no or little experience with what to do following an injury, how to obtain expeditious healthcare and how workers' compensation works.
In Christian's experience, the claims staffers making calls are "usually primarily focused on themselves and their issue, which is managing the claim." In the phone calls that she's listened in on, Christian found that the caller "really hadn't thought much about the practical issues and weren't really prepared to help."
For instance, what if the worker needs assistance deciding how best to get medical care?
Some claims are doubtful, sure, and the worker may not be entirely truthful, but the first message should still always resonate from the caller.
"Even if a claim is suspicious, you should treat the person with dignity and respect, and let the facts develop as they may. There are many sides to the story but there is only one injured worker, and by concentrating on getting them focused on recovery, you will be best served," Marr said.
May 23, 2011
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