No matter how you’re connected to a workers’ compensation claim, you probably share the same goal as everyone else: to get an injured worker prompt, appropriate medical care and return them to work. You want to get on with business and life as usual.
Anecdotally speaking, the overwhelming majority of claims follow a fairly smooth path. An injury occurs, it gets reported, and the injured worker seeks medical treatment. After a few weeks of treatment, the injured worker is released to return to work without restrictions. Any required state forms are signed and returned. After paying any outstanding medical bills that may drift in, the adjuster reviews the file and determines it is appropriate for closure.
I’d venture to say that this scenario is not what typically comes to mind when discussing workers’ compensation claims. Maybe it’s the attorney commercials, maybe it’s the horror stories from your neighbor or distant relative, or maybe it’s because something simply went wrong in the course of a claim that resulted in a negative impression of the system.
What causes some claims to go sour while others resolve without issue?
Information asymmetry due to weak communication.
Communication, by definition, is an exchange of information between people.
In a workers’ compensation claim, there are a lot of people, all with asymmetrical quantities of knowledge, experience, and information. Workers’ compensation is a system that has been historically filled with distrust. Not to mention, a workers’ compensation claim impacts people on a very personal level. When you combine the number of people involved with the emotional impact a work injury can have, it’s almost like a keg of gun powder and it must be handled with care and respect.
Throughout the claim process, there are numerous potential “breaking points.” I’d be willing to bet most of them revolve around communication. Appropriate communication can quell the symptoms of information asymmetry and has great potential to prevent claims from going sour.
Some of these breaking points are provided below, with a simplified version of a solution, focused on communication and empathy.
Problem: The injured worker receives a collection agency notice because of an unpaid bill. I put this one at the top of the list, as it is one of the simplest problems to prevent.
Solution: Injured workers should not ignore a bill or invoice. If an injured worker receives a bill it does NOT always mean the insurance carrier denied it. It may be that they didn’t have the correct billing information, it got submitted to personal health insurance, or to the wrong insurance carrier. A simple fix is to call the billing number on the invoice, and update them with the correct insurance information. Waiting until a collection notice is received makes it more difficult for the workers’ compensation carrier to get an appropriate bill and medical records to make sure it is related to the accepted injury to review it for payment.
Problem: The injured worker doesn’t receive their wage replacement check on time.
Solution: Someone can contact the injured worker to let them know it will be late.
Problem: The injured worker hasn’t heard from their employer for weeks. They’re starting to wonder if they still have a job.
Solution: The employer can make sure someone is reaching out to the injured worker. Just because they’ve filed a claim with their carrier does not mean they shouldn’t check in periodically with their employee. The employer should encourage the injured worker to contact them if they have questions or just to check in if they don’t hear from them.
Problem: The injured worker receives state forms to sign and return and isn’t quite sure what they mean (not a surprise considering the language is typically based on statute or regulations as opposed to commonly used wording). The injured worker gets concerned that they might be “signing off” on something and losing the ability to re-open their claim.
Solution: The injured worker should call their claim representative (who should answer their phone and return their voicemail). Alternatively, the injured worker could call their states’ workers’ compensation bureau, commission, ombudsman, etc. for guidance. They cannot advise the injured worker to sign or not to sign, but can explain what the form means.
Problem: The injured worker is frustrated with their current medical treatment and feels like they should be able to see another doctor.
Solution: Sometimes treatment has to take its course before results are noticed. Proper treatment and recovery expectations should be explained to the injured worker with at the beginning. The nurse case manager assigned to assist the injured worker with navigating their claim can help communicate any concerns or complaints the injured worker is having. The insurance carrier can consider a second opinion, if appropriate.
There are a number of other bumps in the road that can occur with any claim. Communication is a two-way street. Yes, sometimes in a workers’ compensation claim it feels more like a round-about or an s-curve. There are many ways to improve the outcome of a claim, but communication is an easy, cost-effective way that doesn’t require a team of expensive consultants, predictive modeling software or costly vendor to implement.
Remember, when it comes to communication it’s not what you said, what you meant, or how you said it – it’s the message that other person heard that matters.
As the old saying goes, you catch more bees with honey than with vinegar.
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