WC insider: System needs to refocus its methods to reduce disability rolls
As president and CEO of WorkersCompensation.com, Wilson sees and hears from many injured workers confused and frustrated by the system designed to help them recover and return to work. He will participate on a panel of workers' comp bloggers during the National Workers' Compensation and Disability ConferenceŽ & Expo, produced by LRP Publications.
Wilson has become an outspoken proponent of what he believes is a much-needed shift for the industry.
"Ask any room full of adjusters what their ultimate objective is when a new claim lands on their desk, and you will likely hear the resounding chorus, close it," Wilson says. "The system has become very complex, convoluted. It's not geared to the end result of healing as much as closing the claims. Combined with the growing entitlement mindset, we are seeing a huge surge in disability claims."
While that is not totally the result of occupational injuries, it is nevertheless a situation that the workers' comp system can and should address, he says. "It is not a sustainable trend," Wilson said. "We have to find a better solution."
Changing the conversation. Through postings on his WorkersCompensation.com site and in recent presentations, Wilson is joining the growing ranks of workers' comp practitioners suggesting the industry change the way it views and works with injured workers. His vision for the industry is one in which adjusters would change their focus from claims handling to recovery management. Communicating with the injured worker and their immediate family or support network is key, he says.
"Once an injured worker has entered the system, the recovery department's job would be to work with them, so they understand [the employer] provides proper medical care, provides a stipend, and [assists the worker in] going back to work," he said. "People need to understand what is expected. Returning to work is the paramount goal. Today we don't do that."
With the typical adjuster's caseload running at up to 300 files, finding time to communicate with individual injured workers would be tricky, if not impossible. But Wilson believes the continued increase in disability rolls -- and dollars spent -- will ultimately lead the industry to change its behavior.
"Unfortunately, we will get there in a reactive nature when we can no longer sustain the burden the country is dealing with," he said. "Part of it is education, continuing to beat the drum that there is a better method out there."
Such a paradigm shift must be done in small steps. One example Wilson points to is a letter sent to injured workers by Michigan-based Maxcis, a third-party administrator.
Wilson admits that bringing about such a radical change won't be easy, particularly with the money involved. "There are profit incentives across the board that interfere with this process," he explained. "Even among injured workers' attorneys. In reality, they are rewarded for obtaining a total disability rating even though that may not be in the best interest of their client."
Changing actions. "In the interim, people working today, claims professionals have to recognize and understand that every claim they deal with is a human life, and they have direct impact ability," he said. "I don't know if it can happen at the adjuster level. It has to happen on the managerial level."
Utilizing CURE is one solution. Communication, understanding, and education, along with return-to-work structured settlements.
"Outside catastrophic cases, I'd eliminate the settlement," Wilson said. "There would be an incentive. The settlement would improve if [the injured worker] went back to work."
As he sees it, a fund would be available to compensate injured workers for any lost revenue, which would be available upon their returning to the labor force. "I'd get rid of settlements," he said. "Almost anyone can go back to some sort of productive capacity."
At the very least, he says, practitioners should make a concerted effort to inform injured workers about the process. "Right now people do not know how workers' comp works," he said. "They are confused. The adjuster is too busy, the physician is too busy to return calls, so they hire a lawyer and guess what -- he's too busy to return phone calls."
Admitting that changing the workers' comp mindset from one of process and close to one of recovery is radical, Wilson says he's getting good feedback. "They recognize there are challenges because the industry is geared to a completely different structure," he said. "The takeaway is important in the way they communicate with the injured worker."
Wilson related the story of a worker who had been injured within weeks of being hired and was still at the same company more than a decade later.
"The guy said, 'the company treated me real good.' The CEO called him to see what he needed and if there was anything he could do. Then he called the man's wife and told her not to worry, that the company would take care of everything," Wilson said. "They got a 15-year loyal employee for that simple phone call."
By Nancy Grover
Read more at the WorkersComp Forum homepage.
September 16, 2013
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