The end goal of every workers’ compensation claim is to get the injured worker back to work as quickly and cost-effectively as possible. Even with the best intentions, misalignment between parties is common. In this session at WCI’s 2019 Educational Conference, panelists explored creative methods to build stronger alignment between stakeholders.
Moderator: Jim Robert – Owner of Best Foot 4Ward, LLC
- Paul Koziatek – President, Risk Management America
- Jaime Sigurdsson – Director of Worker’s Compensation at CORA Physical Therapy
- Stephen G. Kaufer – Attorney at Walton Lantaff Schroeder & Carson, LLP
There are several parties involved in any workers’ compensation claim and each stakeholder faces different challenges. While everyone’s goal is to get the injured employee back to work, each party has other, underlying objectives, which will naturally cause conflict. Taking ownership, sharing knowledge and communicating effectively are some of the best practices that can be used to realign all parties.
One of the most challenging relationships an adjuster has is with attorneys, especially if dealing with a new attorney who is not familiar with the adjuster’s process and style. It is important for both parties to take ownership of their role so that everyone is aware of their responsibility in the process. Likewise, communication between the adjuster and the employer is imperative. Adjusters have knowledge about the purpose and value of light-duty accommodations and sharing that knowledge can change the discussion.
Risk Manager Perspective
Risk managers are focused on minimizing costs and obtaining the best possible outcome for the employee/patient. Potential conflicts can be both internal and external. Internally, managers and business unit leaders could be using cost allocation models that lead to poor decisions. Sharing knowledge and open communication are important here. Externally, the risk manager and medical professionals may have differing views on excessive treatment and punitive restrictions. It is imperative that risk managers communicate all information to medical providers to give context for the injury so they can develop the most effective care plan. Pre-accident, some possible remedies are implementation of health and wellness programs, onsite training and consistent and pro-active communications among all groups. Post-accident, you can use third-party resources (investigators, nurse case managers, etc.), aggressive return-to-work programs and increase the frequency of claim reviews.
An attorney’s “ownership” is varied, depending on the facts of the claim. In general, they focus on doctors, deadlines and deals. The doctor on file can help or hinder the claim settlement process. Employers, adjusters and attorneys should be able to discuss the best options for successful resolution. Attorneys and adjusters should communicate with each other so that everyone is aware of both legally mandated deadlines and internal carrier deadlines.
Medical Provider Perspective
Workers’ compensation cases are more challenging because there are so many people involved. In a general medical situation, the medical provider only has to worry about the patient’s perspective. In workers’ compensation, the medical provider might also have to work with the adjuster, the attorney or other parties. Internal conflict can occur because the injured worker is focused on pain and may not understand the healing process. Communication between the medical provider and the injured employee is essential. The risk manager, medical provider and injured worker all need to be on the same page about expectations for returning to work and what light-duty accommodations might be appropriate. It is also important for all medical providers to share information. Sometimes patients can be referred to an orthopedic or pain management specialist. Everyone should have all of the information so that the patient can be treated holistically.
The bottom line is this: You should be aware of your role in the process and share your knowledge with other parties. Effective communication between all stakeholders is essential for successful resolution of the claim. At the end of the day, all parties should keep their eyes on the prize – making sure that the injured employee gets appropriate care and returns to work as soon as possible.