Why the workers’ compensation space needs to reframe and refocus to recovery.

By Dr. Claire Muselman

The workers’ compensation industry needs a serious pep talk. Many have lost sight of the original intent of workers’ compensation, to take care of the injured worker. When messaging is added in from the outside world, it appears that everyone is against the injured worker or out to get them, especially the big bad insurance companies and employers! While many of us know this is not the reality, messaging has a substantial impact. People see the insurance world as a contractual and somewhat dark place. The workers’ compensation industry is well established and is thought of as a dreary, difficult, and undesirable system. This cultivates feelings of distrust and overall skepticism when parties collaborate after an injury occurs.  

Insurance was created to restore the livelihoods of people, and workers’ compensation to restore the livelihood of injured workers…getting them back to life. But insurance companies are not the only part of the system. There are many players that can impact this space: insurance carriers, TPAs, employers, friends and family, medical providers, attorneys, nurse case managers, etc.

What can someone do to change this space? From my perspective, it takes someone who cares and believes that you can change the system. It is my goal to share this vision with others to cultivate change through execution, implementation, and simply making it happen!

The industry. There is a need in this industry for a recovery mindset – taking this black and white type of worker’s compensation and changing it into a colorful outlet to restore the livelihoods of those who have been injured. Being in the business of worker’s compensation not only involves state-mandated benefits pertaining to medical treatment and lost time, but we work with people, emotions, and their daily lives. Our job is to indemnify people and restore them through the road to recovery, making them as whole as we can. This differs from other lines of insurance because of the nature of the human body and the impact this has on an injured workers’ purpose or contribution to life. When someone is injured at work and is removed from their employment, temporarily or permanently, they can lose their sense of purpose and feelings of accomplishment through task-based work. Where do you begin? How can we assist in these barriers? What else can we do? How can we make the process better? How can we take the laws and direction given through jurisdictional mandates to improve the overall experience?

The ‘why’ has always been an important aspect of change management. In a prior life, we took change management in workers’ compensation to a new level. We founded, executed, and implemented the first-ever Workers’ Recovery Unit (WRU). The WRU was founded with a new mindset based upon the belief that we (as individual contributors) have the power to positively impact people’s lives each and every time we interact with an injured worker. The WRU continues to focus on recovery, taking the dreary and changing it to positive, and helping people learn to help themselves. Some may call this the advocacy model which has been talked about for the last few years; however, these individual contributors chose to band together to add more flair with glitter and sparkles focusing on the support system mentality, then executed and followed through with doing what they said they were going to do. It really is that simple. Do what you say you are going to do…issue payments, return calls, follow up!

There is a need for this, not only with the insurance/third-party administrator space but with all of the organizations that touch workers’ compensation. This includes the employer level. Open your eyes and look at the industry…even personal healthcare is becoming grey and unhelpful to those who need it which has been depicted drastically with an increased focus on social determinants of health, highlighted by the pandemic. It is time to change insurance for people and the impact within our own scope of control is how we do it. Treating people with kindness, respect, and through education is how we can make injured workers’ recoveries smoother, more effective, and more efficient.

Insurance Carriers/TPAs. Attitude is felt on the phone through tone! Insurance Companies and TPAs have an impactful power starting at the adjusting desk. The initial contact made by an adjuster holds much power as this is going to set the tone for the claim. Speaking with kindness, providing no more than three bullet points with a check for understanding, and explaining a lot of the unknown factors ahead can lay the foundation for a successful relationship on the road to recovery. By simply starting conversations with ‘How are you?’ and waiting to actively listen can have substantial benefits in forming a bond with the injured worker. Working kindly is so important in this industry and can have a substantial ripple effect.

Set realistic time frames and expectations. The more you can explain the claims process along the way, the better understanding the injured worker will have because you are walking them through the experience.

Do what you say you are going to do, simple enough…execution and follow-through are where adjusters find themselves in trouble. If you inform Joe you are going to call him at 3 pm on Wednesday, call Joe at 3 pm on Wednesday. This establishes credibility through accountability and ownership of your word. It builds trust!

Cultivate a vision at the very first call. What does a successful recovery look like for the injured worker? Focus on the ultimate outcome and assist the injured worker with focusing on that recovery aspect rather than the painful situation they find themselves presently situated. If the injured worker is off work, start the conversation of returning to work the first contact focusing on the aspect of recovery.

Explain benefits in a multitude of ways, and then follow up in writing. Having a couple of different avenues of communication available helps reiterate the information you are communicating as well as provides follow-up references. Transparency is key!

Employers. Care about your employees and let them know you care. Workers’ compensation was not designed to be an opportunity to correct poor hiring decisions. Regardless of your opinion of this person, they are an injured worker now in the workers’ compensation system. Our collective goal is to get this person back to work, and back to their life. Try to leave all opinions at the door and approach this as if it were a family member. Be genuine and authentic. No one likes to be injured. Being sincere is important when expressing care and compassion. It is important to remember that workers’ compensation injuries do not go from 8 – 5 pm or stop at the second shift. The impact is 24 hours a day and can be felt through a family.

Establish accountability at the onset of the claim. Layout expectations for the injured worker such as having them check in with you after their doctor’s appointments, so you are aware of their work status/restrictions. This also presents an opportunity for you to sincerely ask how they doing.

Follow Up, especially if they are off work. Send a quick text to simply check-in and see how they are doing. Send a card and if that is not your style, make sure to send a text or call to check-in. The absence of having an employer reach out to their injured worker can result in a plethora of ideas surrounding how much an employer does not care about someone. Bridging this gap with effort will aid in the injured worker feeling supported during this time of insecurity. Keep the injured worker in mind. If there is another company event going on during the time they are injured, is this an opportunity for inclusion? Possible upcoming meeting? Bring them in as they still want to be included.

Communicate. There is power in communication. Work with your insurance carrier/TPA to ensure transparency for the most up-to-date information. Let the injured worker know that you are working in tandem and want to be included to ensure the road to recovery is optimal for the injured worker. This will assist in working towards the vision of returning to work and to life. Be warm and welcoming.

How do you game-change an industry? Care…and believe you can. We should…and all of us can effectively change the workers’ compensation space to a positive light. Get ready, the time is now. We can change this space by each changing one element of the manner we work and interact in this space.

Here is what you can do to make a difference:

·      Target your power of influence. Whom can you help? Why are they important? Are you working directly with injured workers? Do you have influence at the employer level? Be specific and work with the intent on whom you can work with to bring effective change.

·      Influence them to help you. This is a great exercise to help injured workers focus on their recovery as well as an opportunity for an employer to improve their system through small changes. Think outside the box. What does success look like from their standpoint?

·      Teach people how to think. Verbiage is important. This is workers’ recovery; the goal is to restore the injured worker and focus on their abilities on the road to recovery. Remember these are injured humans, not claim numbers.

·      Challenge growth. Ask the right questions. What are you able to do? How can we work together to achieve recovery? What does recovery look like to you? How do we collectively get there? You will not be penalized for being gracious.

·      Role model the way and be the change. The world is changed by your example, not your opinion. Treat others the way you want to be treated. What example do you want to leave, and what will you do with your time here in the workers’ compensation space? 

Dr. Claire Muselman is the Vice President of the Workers’ Compensation Center of Excellence at North American Risk Services, Inc., bringing passion-filled purpose and energy with a dose of glitter and sparkles to the industry.

Using her knowledge with over 17 years of direct claims experience, Claire has been a thought leader in workers’ compensation. She created the first ever Workers’ Recovery Unit, co-hosted ADJUSTED, a claims podcast, co-founded The Transitions, is a monthly contributor for WorkersCompensation.com and Captive.com, as well as Just Begin Magazine and is a bi-weekly columnist for IN TOUCH WC, sharing her love for innovation in the workers’ compensation space.

By combining a solid technical foundation with her passion for creating a better experience through emotional intelligence, empathy, and customer centricity, Claire inspires others to ultimately make good things happen for people. Claire also believes it is her duty and a responsibility to add seats to any table she is invited to participate. She is an Ambassador for the Alliance of Women in Workers’ Compensation, Board Member for Kids Chance of Iowa, Board Member for the Claims and Litigation Management Alliance (CLM) – Workers’ Compensation Advisory Board, Founding Member for the Women in Insurance & Financial Services – Iowa Chapter and is President of the Insurance Association of Greater Des Moines (part of the International Association of Insurance Professionals).

Claire also speaks nationally on the topic of Humanity in Claims, Compassion in Safety, and Emotional Intelligence in Leadership looking to change the industry one insurance professional at a time. “The adjusters we are empowering today will be the decision makers tomorrow. Advocacy is not enough, we need empathic, emotionally intelligent leaders who understand the bigger picture of returning injured humans to functional, contributing members of society and more importantly, returning injured humans to their own lives. The ripple effect matters.”

In her free time, Claire enjoys being an Adjunct Professor at Drake University teaching Compensation & Benefits, Leadership, and Public Speaking to students in the College of Business & Public Administration. She enjoys being active outdoors, traveling, and spending time with her daughter as well as her fur family – Teddy, Kees, & Storm.

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