Are too many claims opposed? Some large employers think so


Employers may get excited that tackling some workers’ compensation claims and medical treatments can be counterproductive, and a new emphasis should be placed on keeping injured workers happy – and out of life. courtroom.

“The worker compensation system should be self-executing and a lot of times it isn’t,” said Michele Adams, vice president of risk management for risk management at Walmart.

Adams spoke at the 75th Workers’ Compensation Institute convention Mondaye annual educational conference in Orlando, which organizers say is the largest gathering of worker compensation professionals in the country. The opening session was provocatively titled, “Does our system hurt?” And included a range of speakers who said that, at least in some cases, the answer is ‘yes’.

Susan Shemanski, vice president of enterprise risk management at Adecco Group, one of the world’s largest temporary staffing firms, appeared to dispute the limits on the amount and duration of benefits that a number of State legislatures have passed in recent years in an effort to cut costs. to employers and insurers.

“It’s really not fair to the injured worker. I think this is an area that hurts the injured worker, ”Shemanski said.

“It’s almost like a penalty for doing well,” Adams added, noting that better benefits can help recruit and retain good workers.

Shemanski added that some injured workers were plunged into conditions bordering on poverty while living with a comp disability, considered suicide, and turned to opioid drugs for physical and mental stress relief. She told the story of an amputee who could not afford the price of his car with the level of allowances he was receiving. This, in turn, made it difficult for him to get to work when he was ready to return.

About 90% of reimbursement requests are accepted and paid without much disagreement, the panelists said. But about 10% end up in litigation or mediation, and that’s too much. When injured employees feel cheated or ignored or denied benefits, or faced with usage reviews, it prompts many people to seek legal advice, dramatically increasing settlement costs. claims, they said.

“I perceive that there is too much inclination towards litigation,” said David Langham, the chief workers compensation judge in Florida. “I’m probably not going to befriend that statement, but I think there are probably too many lawyers among us who don’t have much else to do.”

The advertising of plaintiffs’ attorneys, especially in Florida, is so common now that workers can’t help but feel they owe more than the amount of benefits they can receive, the panelists said. Seeing claimants taken care of, with appropriate benefits, can get them back to work sooner – and away from television and its steady stream of lawyer ads, they argued.

At another WCI session, on managing risks and exposures to improve employer outcomes, adjusters said paying special attention to injured workers was increasingly accepted across the country. . “Claims advocacy,” in fact, has become the new buzzword in the industry, said Scott Clark, Florida-based vice president and claims advocate for Arthur J. Gallagher Risk Management Services.

“Injured workers who have become isolated go to law offices where they think they will be represented,” Clark said. “And you don’t want that.”

He said employers should make sure injured workers are involved and informed of the claims process, every step of the way. This includes seeking applicants’ opinions on medical treatment and often referring them to a medical specialist, not to a “doc in the box” emergency care clinic.

Adams, of Walmart, said that with benefits and procedures so different from state to state, new efforts should be made to find the practices that work best and reduce friction in the system. And with so much data now available, surely it is possible to find other ways to use it, along with artificial intelligence and knowledgeable adjusters, to avoid contentious claims and unnecessary usage reviews.

After several tornadoes ravaged parts of the South and Midwest on Saturday, injured workers and the families of killed workers will now enjoy a wide range of benefits. Some will receive more help than others, conference officials said.

In Kentucky, one of the hardest-hit states by tornadoes, workers at a candle factory saw the building collapse around them, killing up to two dozen workers. But some of those workers will not be eligible for post-traumatic stress disorder benefits, said Dwight Lovan, former State Department worker claims commissioner.

Kentucky law, unlike the laws of several other states, only allows mental stress benefits if the worker has also suffered a physical injury.

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