Cumulative Trauma Claims

• Jennifer Cogbill – Senior Vice President | Gallagher Bassett Services
• Pam Ferrandino – Vice President, National Market Engagement | Gallagher Bassett Services
• Sherri Johnson – VP Corporate Claims | Aimbridge Hospitality
• Carol Ungaretti – Managing Consultant | Aon

The Aging Workforce

The aging workforce has caused critical issues in CT claims, particularly with regard to the length of the claim closure. Proactively speaking, this makes, risk engineering and ergonomic solutions critical to assist with their needs. However, employees have to be able to break habits and utilize these tools to mitigate risks. When CT claims do occur, the individuals that will need additional assistance should be identified early.

Early Investigation and Reporting

The claims investigation process is best assisted when adjusters use their ISO report to identify what other accidents or injuries exist. In the instance that the injured worker had previous injuries, other employers may need to share the costs associated with a claim, especially when they are short-tenured. Employers should lean on the advice of their attorneys and adjusters for how to proceed with a claim. All stakeholders should work together to create a claim value, determine what abilities they have to progress the claim, and what can be controlled if it is advancing to litigation.

Behavioral Health Issues

It is important to remember that behind every claim is individual with other complex injuries, including behavioral health exposures. A large percentage of CT claims include soft tissue injuries and mental health conditions. Stakeholders should rely on their network of evidence-based clinical providers that can recognize comorbid conditions, including anxiety, depression, stress, and PTSD. These an be ongoing for the lifetime of a claim and their identification can provide insight into the full exposure of the claim.

Operational Changes

COVID-19 caused an influx of post-termination CT claims in many injuries Unfortunately, when one employee starts discussing their claim and the potential for attorney involvement with their colleagues, it can result in mass CT claims. Oftentimes this happens when employees are afraid they could lose their income and reach for other sources of income. It could result from fear around incoming new management, but early training to address the issue can help contain and resolve the potential for mass CT claims.

For employers dealing with mass CT claims, set the expectation for the remainder of the claims once that initial employee is paid. Divide the claims by tenure, the amount of body parts injured, etc. and consider settling early. Defense costs are expensive and will only continue to worsen.

Advocacy Model

Advocacy is not the same as just adding a nurse to the case. It is about providing support and leadership to someone in need to resolve their claim and return them to work and life. The goal should always be to guide the injured worker using the resources on the claim. A supportive model will check in on the injured worker’s pain, engage them consistently, help with appointments, and connect them to providers. It will also include performing a psychosocial evaluation to get a more holistic view of their recovery. This approach reduces indemnity spend, recovery spend, and the potential for litigation.