“I wish I would have known then what I know now”
Typically, there’s never a happy ending after this statement, “Because, if I knew, I would have done things differently.”
So, after years of uncontrolled rants on workers’ compensation claim management, I think I’ve made a dent. We’ve created a checklist that identifies the leading indicators (predictive modeling) that produce adverse outcomes. Yes, these claims cost you a lot of money and time.
Employers blame insurance companies, insurance companies blame employers and doctors’ blame everyone.
It’s not the cut finger or catastrophic injury, we get that right? It’s the soft tissue, neck or knee coupled with the employee who has a sense of entitlement, unhappy at work and has a long list of co-morbidity issues. “Houston, we have a problem.” – crew of Apollo 13
The problem is, these injuries migrate through the adjuster system with no real sense of urgency and strategy to bring quick closure that will reduce the duration and cost of a claim.
So let’s be more specific and use the Pareto Principle or 80/20 rule. It’s the 20% that’s driving 80% of the cost.
Can we agree the system is wrought with fraud, waste and abuse? If so, you can no longer rely on the treating physician, adjuster, pharmacist, injured worker and the cast of supporting vendors to keep the cost down. You have to take control by gathering the information to determine the characteristics of the type of injury, employee and treatment plans, have enough red flags that have historically led to adverse outcomes and delayed recovery. Here’s a few to think about:
- Was the employee recently reprimanded?
- If you’re aware, does the injured workers spouse collect disability benefits?
- Are there co-morbidity issues with the injured worker that would complicate recovery?
- If litigated, does the injured worker owe back child support?
- Did the injured worker complain about treating physician?
You get the idea. By shining light on this information with the adjuster you can develop strategies to mitigate or deny this claim. Take it one step further and ask:
- Are the accident investigation, witness statements, employee report of injury and physician notes consistent?
- Has the employee been injured before and if so, was this an aggravation to a prior injury?
- Are prescriptions filled by treating physician or an independent pharmacy?
In summary, there’s a widening gap of talent in today’s workplace. The fundamental job of H.R. Professionals is prediction. It’s the ability to combine big data intelligence with gut instincts. Here’s your opportunity to scale up and lead. Let’s create the new normal, push back and refuse to let a broken system be our guide.
Duke Mills – President
WorkComp Solutions, Inc.