This collaborative session presented by Sarah Perry, ARM-P (Risk Manager, City of Columbia, MO) and Kathy Peeling, CPCU, ARM-P (Assistant Director for Risk Managment, University of Maryland) at the 2019 PRIMA Annual Conference engaged the audience in a discussion on high-frequency claimants. Kathy led the group through identifying why frequent claims happen to a few people. Sarah then offered ideas on communicating claim frequency to entity managers and strategies to mitigate these circumstances.
Who are the Repeaters? How will you define accident repeaters?
Kathy suggests a combination of defining how many accidents during a specified period and using data including reporting, medical information, and lost-time. If you can gather data for a minimum of 5 years, but the longer the better, you can start with focusing on employees incurring incidents more than once per year.
Kathy talked through analyzing the data available, encouraging focus on both frequency and severity and understanding the context of the incident. Look in to both repetitive motion injuries, and re-injuries/related injuries. Your pool may be able to provide more accurate and representative data than national databases like NCCI in regard to repeat claimants.
The aging workforce was identified as a leading classification of frequency risk. Workers over 65 are only growing classification of claims in frequency as an age group. Workers over 55 are costing more money per claim related to healthcare costs. Some root causes discovered include:
- Decreased stamina for physical tasks
- Increased reaction time
- Need for greater illumination
- Hearing loss
- Increased recovery time
- Financial need to work until older
- Substance abuse
The audience then offered their experiences in identifying high-frequency claimants and some of the psychological causes including:
- Easy money
- Light duty
- Healthcare cost
- Long term planners/Retirement planning
- Hierarchical Inattention
- Beef with management
- Perceived job security tool
More natural human root issues
- Anxious Rush
- Job or Family Stress
- Work ethic
- Work habits
Kathy & Sarah reviewed an article published by USA Today with 2017 data of 25 riskiest jobs and identified the public entity related jobs:
- Sanitation workers
- Roofers/construction workers
- Utility line workers & power workers
- Teachers and coaches
- Search & rescue
Kathy and Sarah briefly talked through why the public sector seems to have more frequency than than the private industry. Their research suggests some of the following reasons:
- Same employer longer – 83% longer
- Lack of upward mobility
- Repetitious tasks
- Safety Culture
- Loyalty to unit, not administration
Kathy and Sarah led the audience in a discussion of the type of data needed to best understand and identify repeat claimants. The group suggested:
- Severity of Injury
- Days of week
- Near Misses
- Body part
Sarah said ultimately set some parameters to help make decisions. Decide how many incidents in a specific time frame begin to become unreasonable. Establish a matrix that will help you assign a repeater index and level of impact. That matrix can help you identify a scale, for example:
- 1.00-1.25 Little if any problem
- 1.25 -1.50 Problem may be developing – early intervention could be useful.
- 1.5 – 1.75 You have a problem. It’s not going away.
- 2.0 + The problem is major, involve your carrier or third party administrator, case managers, and medical providers and get going!
Next Sarah briefly walked through a communication and support plan with top management. Identify who needs to understand and can implement intervention and correction strategies in your organization. Establish a regular reporting process, Sarah suggested about every six-months would be appropriate as data can collect and provide actionable insights. Lastly, be careful with what details are reported to this group, being cautious of providing enough information to encourage improvement strategies, but not to too granular with information to protect data information privacy.
Finally, Sarah discussed organizing intervention strategies to mitigate high-frequency claimants.
- Establish the right team which can include: HR (HR Director, FMLA/ADA representative, Union Representative, Retirement representative), Risk Management-Occupational Safety, Legal, Department Managers/Supervisors, and Claim Manager.
- Implement and communicate the availability of resource programs including training, medical evaluations, fitness for duty, and employee health/wellness.
- Establish an Intervention plan
- Pre-Meeting – meet with employee’s supervisor
- Meeting with Employee – avoid blame, seek answers, show concern, ask what support they need
- Follow Up with Employee – look for things to celebrate.
- Culture Evaluation – where can the employer make positive impact?
- Involvement and representation of employees
- Does everyone feel heard?
- Mechanisms for reporting safety issues
- Safety Committees.