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By Steve Yahn

Amy Middlebrooks joined Dublin, Ohio-based health care case manager and vocational rehabilitation specialist VocWorks in late July. But before that she left a lasting legacy at Big Lots, the giant closeout store chain in nearby Columbus.

"I knew when I first came on board I just had to jump right in on these two issues," she recalled. "With regard to the older claims, I knew I had to take control of those claims as well as future claims. If we continued to pay for non-allowed conditions through out-of-pocket expenses and these claims kept going on, obviously that leaves a reputation for that continued practice and that wasn't cost-effective for the company.

"So that's basically how I started," Middlebrooks said, "And as the associates from the warehouses came in with further injuries, we developed more of an investigation program and were able to obtain more detailed information to help narrow down what conditions would be, plus determine the mechanism of injuries matching what the injury actually was."

At that point, Middlebrooks and her team spoke with the company's legal counsel to make sure they were within their rights to medically manage claims at the warehouses. They then set up client service instructions with their third-party administrator and developed case management roles for nurses. "These were set up in the warehouses so we could properly manage our claims since we see them on-site with our doctors anyway," Middlebrooks said.

"It is 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 supervisors and actually go to the site to see how the person was injured, what was the area and is there something around it. Because a lot of times what I've seen is these accidents occur and without a proper investigation, the claims were being approved or denied and the mechanism of injury didn't match with what the injury was. They didn't correlate."

Big Lots has 1,785 employees in five jumbo warehouses. Each Big Lots warehouse has a medical professional that runs the facility's occupational health clinic. Those individuals have been trained to medically manage cases to ensure that the company can more effectively control workers' compensation costs. In each clinic, every injured associate is seen by the medical director who provides consultation on the injured party's treatment.

In addition, Big Lots' nurses work closely with the company's third-party administrator to manage workers' compensation claims. This ensures that its nurses are managing the claims to provide for proper medical treatment and reduce costs associated with the treatment. Workers' compensation is self-insured and self-administered at Big Lots operations in Ohio. Sedgwick CMS is the company's third-party administrator in Colorado, Alabama, Oklahoma, California and Pennsylvania.

As a result of Middlebrooks and her team, Big Lots gained full control over its medical claims management process. Claims are closed more quickly and aging claims have been resolved. In addition, the company has taken steps to be more pro-active about reducing the opportunity for on-the-job injuries and has seen a decrease in overall workers' compensation claims. And, with the new process in place, most of those associates who are injured are on modified duty.

On another front, Middlebrooks worked closely with Columbus, Ohio-based Progressive Medical in maintaining the pharmacy program for the Big Lots distribution centers.

"We reviewed the programs in place and closely monitored the prescription medications being distributed to our injured workers,"Middlebrooks said. "We were able to watch this closely due to the requested reports Progressive's Dana Sherwood provided. By monitoring these reports we were able to see addictive behaviors, and if proper drug testing was being performed on each injured worker with a history of medication usage related to the injury."

In addition, Middlebrooks and her team were able to see if medications were being prescribed that were not related to a claim, thus facilitating better communications with physicians. Also, by reviewing these reports, Big Lots staffers were able to see if multiple medications were being prescribed that might not work well together. In questioning these methods, Progressive had an on-site pharmacist available to assist Big Lots in talking to prescribing physicians and presenting safer alternatives.

Of working with Middlebrooks, Sherwood said: "Amy has the background to know everything about what she's doing. But on top of that, she is constantly researching issues. She is one of those people who works with you as a partner. She doesn't treat me as just a vendor. She also really cares about the patients she works with."

Another initiative that helped Big Lots gain more control over the claims management process was training medical professionals on the accident investigation process.

"This gives medical professionals a full understanding of how accidents occur and the mechanics involved in an injury," Middlebrooks said. "That is, was the injury truly the result of the job duty they were performing, or outside factors. This training is useful in determining if a claim should be approved and encourages medical professionals to ensure that a detailed investigation occurs for all claims."

The company denied several inappropriate claims as a result of the new procedure. It also allowed the company to curb injuries by allowing employees to take protective measures.

Middlebrooks credits the risk management team at Big Lots with a major role in bringing about the many changes at the company.

"They were very energized about the approaches we were taking," she said. "They were instrumental in helping make things run more cost effectively and to help close a lot of old claims."

In her current job as a field nurse case manager at VocWorks, a division of CareWorks, Middlebrooks works with employers and third-party administrators to handle their workers' compensation claims and helps to assist injured workers with their medical treatment and return-to-work programs.

A key part of her job is to help workers get the medical care they need to go back to work and function normally in their daily life.

"This is case management from a different perspective, of course," Middlebrooks said. "We medically manage all the cases. We go to doctor's appointments with the workers and handle all pharmacy and durable medical equipment issues on behalf of the employers."

In her short time at VocWorks, Middlebrooks already has written light duty job descriptions for a transportation company to assist it with placing injured workers back to work with restrictions. This assists companies in having documentation to support any modified duty program and keeping injured employees at work.

Cathy Jackson, a worker's compensation adjuster at Forward Air who currently works with Middlebrooks, said of her: "Amy's personality reflects a lot on her. She is very easy to work with. Her knowledge is exceptional. The last time I met with her she gave me some terrific ideas that helped me out a lot. She just seems to be the type of person you want to work with."

Anotherperson who is not surprised by Middlebrooks' success is Anna Steinburger, a telephonic nurse case manager at Sheakley Unicome who worked with her at a previous company.

Steinburger said of Middlebrooks: "She is so good at handling risk because she doesn't enter anything without a knowledge base. And she knows how to use that knowledge to the fullest benefit for those around her and for her company."

There was never much doubt that Middlebrooks would end up in the care-giving world.

After receiving an associate's of applied science in nursing degree from Lima Technical College/Ohio State Branch in Lima, Ohio, Middlebrooks went to work at a factory that made seats for Honda cars. She eventually discovered that the company had an occupational health position open. "They started to include me in the safety aspect and I liked it. So I started safety training programs and began to look at equipment from a safety perspective."

Following that position, Middlebrooks joined VP Buildings Inc. in Van Wert, Ohio. There she wrote the company's safety program from the ground up, coordinating and managing all health and safety practices within the company's manufacturing facility, including supervising all employees on their safety performance. Under her leadership, the facility went 450 days with a lost-time accident.

Middlebrooks was recruited away from VP Buildings Inc. by Corvel Corp. in Dublin, where she served in many capacities, from field and telephonic case manager to nurse reviewer. Among other things at Corvel, she completed comprehensive personal and auto liability medical reviews with employers, third-party administrators, attorneys and insurance companies.

From there the fast-stepping Middlebrooks moved on to Big Lots.

STEVE YAHN has been a reporter and editor for national publications. He can be reached at riskletters@lrp.com.

December 1, 2011

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