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Disenfranchisement of the Workers’ Compensation Recovering Worker

What causes a worker recovering from a workplace injury to become disenfranchised? We observe that it is a system that rewards removal of the direct, human interaction between the adjuster / examiner and the worker.

While we have for over 16 years pushed our agenda out to insurance companies and self-insured organizations, the push from the top brand national Third Party (claims) Administrators (“TPAs”) has been moving to work-from-home claims people, decentralized processing, paper moving efficiently to a paper-less environment and a one-time, flat rate charge for professional services. Unfortunately, the only contact between a recovering worker and the TPA is by telephone, e-mail or text message. They have no one to sit down with, talk about their issues and concerns or air their grievances. Except to seek the assistance of legal counsel, friends, neighbors or those that have previously been touched by the WC system. The lead player in the injured worker’s recovery tends to be people other than the individual / organization responsible for the management and direction of the claim, the adjuster / examiner. We recently heard a quote from a claims professional working for a national TPA in a work-from-home capacity, the person liked the position better than prior claims positions because they “don’t have to get so emotionally involved” with the workers.  That person’s job satisfaction was higher BECAUSE they did not have to engage and encourage the healing of the recovering worker. This isn’t one person’s issue, it is a systemic issue within the workers’ compensation community that has begun to turn its back on the recovering worker and incentivises such behavior of those on the claims side.

Our agenda is contrary to the national movement.  We work together as a team, adjuster/examiner/assistant, nurse, supervisor, treating provider with the goal of empowering the recovering worker to take control of their healing and be knowledgeably engaged in the workers’ compensation process. We encourage workers and our staff to meet, face to face, to talk frequently and to operate as transparently as we can with the restrictions in the laws and statutes. We have a room dedicated to meetings with recovering workers which is in use nearly every day. We are dedicated to reversing the trend of impersonalized workers’ compensation claims, one recovering worker at a time.

Engaged recovering workers heal faster and more completely than the disenfranchised. Faster and more complete healing leads directly to a higher level of satisfaction of the recovering worker and lower litigation rates, significantly reduced lost time benefits, reduced permanent impairment ratings, and, for the insurance company, employer and self-insured organization, a significantly total cost. Not only is it the right thing to do for legitimately injured workers, it is far less expensive when the total program cost is considered.

Mr. Marsh will be speaking about the Humanization of Workers’ Compensation at the National Council of Self-Insureds annual meeting in San Diego, CA on June 5, 2017.  For more information about the convention, go to the National Council web site.