By Nancy Grover
Denise Zoe Gillen-Algire. A registered nurse board certified in occupational and environmental health, a board-certified case manager, and a fellow of the American Association of Occupational and Environmental Health Nurses with an MBA, Ms. Gillen-Algire is the practice leader for integrated health and productivity management with the Risk Navigation Group. She has designed and implemented integrated disability management programs, performed valuation of national provider networks, and consulted on performance metrics design and implementation.
To Gillen-Algire, concerns over future liabilities are "what keep most insurance companies and payers awake at night." As she says, a lot of things can affect a claim, "depending on comorbid conditions and just the marketplace in itself -- an employer's ability to bring people back to work, how claims develop over time."
One bright spot she is seeing is a return to a focus on safety and wellness among employers. "When I first entered workers' comp, there was definitely a palpable focus on safety, prevention, and worker education, but as the market changed and things got pretty tough within companies and employers, some of those went by the wayside," she said. "I think we are seeing some increases. Companies are seeing the value of safety and also wellness and managing the comorbid conditions that have a significant impact on claims outcomes, both for occupational and nonoccupational injuries."
Mark J. Noonan.
The managing principal and senior knowledge manager for workers' compensation for the casualty practice at Integro Insurance Brokers, Mr. Noonan oversees state relations, coverage issues, vendor relationships, and various technical functions. In his more than 30-year career, he has worked as a defense trial lawyer, risk manager, and claims manager.
The uncertainty of health care reform is a major concern, especially "how it will impact the delivery of medicine and will it encourage physicians to get out, or not specialize in areas that workers' comp needs specialization in?" he said.
Another challenge is what he says is the loss of expertise among claims administrators. "Claims issues are becoming more complex," Noonan said. "Yet, the ability and talent levels are not increasing among us."
Noonan believes that while technology has improved efficiencies in the workers' comp system, it has taken away the humanity.
"When I started as an adjuster, I went to people's houses, took statements. I got to see what was going on. . . . I resolved a lot of claims across the table," he said. "We've really desensitized ourselves to the human issues, created more opportunity for fraud, more dishonesty, and for more controversy in the system."
His solution? Better contact with the injured worker -- first and foremost, by their employer and done with respect and concern for their situation and not "checking up" on someone.
A seasoned veteran with more than two decades in the workers' comp system, Mr. Walls is the assistant vice president of claims for Safety National, a leading provider of excess workers' comp coverage. In addition, Walls is the founder and manager of the Work Comp Analysis Group on LinkedIn, the largest online discussion community dedicated exclusively to workers' comp issues with more than 13,000 members.
The biggest challenge he sees is rising medical costs, especially the use and abuse of opioids.
Additionally, Walls is concerned about one of the recent ramifications of the economy -- returning injured workers to their companies. He says employers are increasingly hiring able-bodied employees.
"More and more we are seeing employers saying, ah, if it costs me more so be it. It will hurt me so much more on the production side than it will on the comp side," Walls said.
Finally, Walls sees the impact of the aging workforce on comp. "You go into any claims office and you don't see a lot of 20-somethings, you see a lot more 50-somethings," he said. "It's not like anybody is coming out of college saying 'Man, I hope I can get a job as a comp adjuster!'"
The 21st annual National Workers' Compensation and Disability ConferenceŽ
& Expo takes place at the Las Vegas Convention Center, Nov. 7-9. The conference is produced by LRP Publications.
February 13, 2012
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