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By DAN REYNOLDS, senior editor of Risk & Insurance®. Freelance writers Lynn Rosen and Steven Yahn contributed to this article.

The surest conclusion one can reach when looking at some of the latest improvements in claims management and return-to-work programs is that the compartmentalized approach to worker injury and work return will surely fail.

Not, mind you, investigators like Peter Falk's Lt. Columbo, that is, someone who is trying to get to the bottom of an incident so that they can assign blame and make an arrest.

But rather, someone who is engaged and motivated to analyze a work system and implement solutions that make workers safer and get them back to work more rapidly.

As we recently parsed the applications to this year's Risk Innovator? contest, we found numerous examples of managers who were tinkering with progressive ideas in the area of claims management and return to work.

In many cases, these managers had come to similar conclusions about how to tackle specific problems, and provided excellent examples of professionals who are part of a wave of improvementsweeping through the industry.

Take Amy Middlebrooks, head occupational nurse for the Big Lots Inc. retail chain, based in Columbus, Ohio. She developed an investigative program that looked into the relationship between the mechanics of the workplace, and the injury listed on the claim. In many cases, the workplace mechanics and the injury didn't match.

Middlebrooks set up medical managers for each Big Lots warehouse that oversaw an occupational health clinic. Those occupational nurses know where the injury occurred, and they have had first-hand experience of treating the injured worker.

That experience makes them more qualified to be interacting with Big Lots' pharmacy benefit manager, Columbus-based Progressive Medical, in managing that worker's recovery when they are off-site.

"It's very important to look at an accident and how it occurred, and then look at all aspects of the accident and talk to the injured person, and talk to the supervisors and actually go to the site to see how the person was injured,'' she said.

Many times accidents occur but the follow-up investigation is inadequate. Claims are approved or denied, but the type of injury suffered often doesn't match the mechanics of the workplace, Middlebrooks said.

And here we have an example of the seamlessness that we are presented with in managing an injured worker, and the challenges of returning them to work.

For what good would it be to pay for the pharmacy costs and the physical therapy of an injured worker, and then return them to the workplace without understanding the nature of the environment in which they were injured? How many times have insurance companies had to pay for that cycle of injury, therapy, return to work and injury once more?

That's also the cycle that Karl Nennig, medical services administrator for Milwaukee, Wis.-based We Energies, wants to avoid. Again, in the spirit of an engaged investigator, Nennig formalized his case management process to document every employee injury, even if that injury did not occur on the job.

Nennig and his colleagues take pains to comply with the Americans with Disabilities Act and Equal Employment Opportunity Commission regulations to make sure that workers are not pushed to come back to work until they are ready.

A key piece of the work is educating the employee's manager or direct supervisor, so that managers are clear on federal regulations and don't run afoul of them in their zest to manage more productive departments.

In addition to taking a close look at injury documentation, Nennig guided his company into a culture in which not just injuries, but near misses are reported electronically and anonymously.

Confidential reports can be submitted on workers not wearing hardhats in construction areas, or jaywalking in traffic, for example.

Neil Levins, corporate wellness and disability program manager at Chrysler Corp., is another of this new wave of professionals bringing progressive investigative methods into the realm of workplace injury and return to work.

Levins set about changing a culture that had been using a nucleus of medical providers to treat on-the-job injuries. He installed a system of occupational specialists, trained claims examiners, and a "rehabilitation concierge,'' to process claims. The concierge helps employees in making appointments and oversees the care delivery process.

Before the new team even treated its first injury, the occupational physicians and rehabilitation specialists toured the Chrysler plant to understand its operations, its job demands, its environment and its workplace characteristics.

The new team also toured Chrysler's rehabilitation facility to see first-hand the treatment that injured Chrysler employees were getting. The spirit of that visit was that the specialists could engage in an open discussion about the rehabilitation techniques being used.

As a result of the tours, Chrysler implemented a new one-stop shop approach for the care and treatment of injured workers and has created better return to work results.

Professionals like Levins and Nennig are improving communications as well. Nennig is pushing for more data, for example, having employees report near misses confidentially and electronically.

Levins is helping caregivers better understand the demands and dangers of the workplace, so that they can rehabilitate workers and bring them back into a safer environment.

Yet another risk management professional is taking seriously the importance of communication in avoiding injury and accelerating the return of workers to their jobs.

As director of risk management for Penn National Gaming, Jacques Arragon manages risk for the third-largest gaming company in the United States.

His is not a manufacturing environment, but Arragon no doubt leans on his experience in the high-risk area of manufacturing and his work at Penn National has investigative roots.

Before coming to Penn National Gaming, Arragon was a corporate risk analyst at Ford and worked on the consulting side as a senior casualty advisor at Marsh.

Like Middlebrooks, Levins and Nennig, Arragon initially took a hands-on approach to delving into the mysteries of workplace injury at Penn National. Arragon toured each of Penn National's facilities with that site's risk manager.

He wondered, are the knives properly sharpened? Are the correct gloves being used? What about those old wooden buffet tables with the metal trim, a frequent source of cuts. Are they in proper condition?

"My goal has always really been to try and prevent injury,'' Arragon said. "We do a lot of work in loss analysis and understanding where it comes from.''

But Penn National, with 26 properties around the country, is growing rapidly and there was no way that Arragon could keep making those on-site visits and drill down into the risk on everyone.

To get the company where he thought it needed to go, Arragon created an electronic risk management and safety reference manual with 13 sections that would give Penn National's 15,000 employees the information they would need to be safer in their workplaces.

The manual includes the latest guidance from OSHA, the National Institute for Occupational Safety and Health, and other organizations dedicated to worker safety. The document contains hyperlinks that connect the user to the web sites for sources of government standards.

"It's not a static document,'' said Janice Schnabel, the managing director and global hospitality and gaming practice leader for Marsh. She helped Arragon develop the manual.

It took the Marsh team 10 months to assemble the document and make sure all the links were in place.

"You can be forward thinking in a low-risk environment, but it's not something you see very much,'' is how Schnabel describes the dynamics of what Arragon is doing.

So, Arragon is firmly among them, this new wave of claims management and return-to-work specialists who see worker rehabilitation and return to work not as some adversarial game of cat and mouse, but as a system that needs a sort of science to unlock it and improve it.

October 1, 2011

Copyright 2011© LRP Publications