Breaking the Cycle of Entitlement: How Do We Get Better?

03 May, 2012 Bob Wilson


How do we get better? It is a question that can and should be asked at many levels in workers' comp. How do we efficiently manage our workload? How do we improve care for the injured? And perhaps most importantly, the injured worker should be asking, "How do I get better?"

Part of our job is to guide them to that question, and help them find the answer.

Peter Rousmaniere wrote a very insightful piece this week that encapsulates this issue nicely. He addresses the "disability mindset, abetted by external enablers", as the probable cause for ever increasing medical and claim costs, and he could not be more on target.

For the better part of the last 12 years, I have had the distinct pleasure of managing what has become the largest independent online source of workers' compensation information for professionals and the general public. Our public site,, is open to all, and as a result we see a wide array of visitors with varied and competing interests pass through our virtual doors. Of the 20,000 or so who use our services each day, the vast majority are employers and industry professionals, but about 20% are either injured workers or people researching on their behalf. While our professional discussion area is now the Workers' Compensation Roundtable on, the public discussion forums on our site are virtually owned by injured workers. Many end up there, and over the years, this has given us tremendous insight to the thought process of many of those in the system.

I have been troubled over the years that the question that seems to be asked most often is not "I was injured, how do I get better?", but rather "I was injured, how much will I get?" While some responsible people advise them that their health is their primary concern, advice abounds on getting financial help; food stamps, SSDI, and other forms of assistance designed to aid and further the dependency of the injured. Add to that the barrage of marketing the injured worker is exposed to informing them of all their rights and entitlements, in addition to over tasked claims professionals for whom "closing the claim" is the overriding goal, and it is a recipe for a newly dependent class: the permanently injured.

It doesn't have to be, and in fact, is not, a sustainable trend.

So the question remains, how do we get better at getting people better? There are several key components to this.

Meet the “Recovery Specialist”:
In a prior world we knew you simply as an adjuster, or claims person. Sorry, the title and industry mindset need to change, and it starts with you. I know that is a lot to pin on one person, but you are the centerpiece to effective recovery management. You are the central person that deals with all the critical stakeholders, and the recovery mindset must be first and foremost in your collective conscience. Look at the 150 or so cases on your desk. Each one is a person, and right now, in this moment, you have a tremendous influence on what happens in their life. You can make a tremendous impact. You can do this. That is why you are a Recovery Specialist, instead of “just an adjuster”.

I would add that, if I were an injured worker, having a Recovery Specialist assigned to my case sounds a whole lot better than getting an adjuster.

Studies show that the longer a person is off the job due to illness or impairment, the less likely it will be that they successfully return, and the likelihood that their health will deteriorate increases dramatically. Injured employees must be made to understand that getting well is in their paramount interest, and returning to the job - even a modified one - is the best thing for them.

This is a challenge, as there is a great deal of employee mistrust in the comp arena, fed by employer indifference and misinformation, as well as by parties whose profit incentives do not necessarily align with the workers best interests.

Return to Work:
Get them back on the job; return them to a viable, contributing position. I have heard people say that getting them back in any job, even a meaningless, trivial one, is best for controlling claims costs. I disagree. I would entertain the notion that returning them to "a" job is critical, but it has to maintain a relevance that brings value to all. A person put in a room to count paper clips will not be a happy, productive employee, and will shortly become a cancer in your operation; at least until their next claim takes them out for good.

Employers are key to this process, right down to the front line supervisor. EVERYONE must understand the importance of keeping people working and productive. If all players in a company do not buy into this, it is all out the window.

Listen to the Injured Worker:
I would bet this is the area in which we, as an industry, fail to the greatest degree. Overworked adjusters, doctors with increased patient loads, employers who resent the claim (and the claimant, who prior to the injury was a star, but is now a malingering fraud), all contribute to the "patient mill" mentality, where we find we are merely pushing paper while managing claims, and not helping people recover.

That "claim" is a human life, with hopes, dreams and aspirations, and it deserves to be heard. I am not suggesting we patronize the injured - if their expectations are unrealistic they need to be told that in no uncertain terms, but they must be heard. In fact, I would make the argument that an effective Recovery Specialist would rely heavily on what I call compassionate honesty. Understand and sympathize, but tell it like it is. An employee who finds a receptive ear, who can "vent", who understands that YOU  understand and will be straight with them, will be far more receptive to options and suggestions to improve their care and get them back on the job.

I can tell you that some of these people, particularly those with permanent, life altering injuries, are angry. They resent their condition, and everything associated with it. They want to do everything they used to be able to do. They want to be fully restored to their prior health; they want to be normal, and that is something that is never going to happen. Someone needs to listen to them, and be empathetic to their concerns.

There are other important factors, but to me these areas are critical for the task at hand; getting better at what we do.

This industry manages over 14,000 new claims every day. That is 14,000 human lives. To really address the question of "How do we get better?” we need to make a fundamental shift in the way we view those statistics. An adjuster should be renamed, and must view themselves as, "Recovery Specialists", and learn to operate under that mindset. They will be up against many ingrained, institutional challenges. There is an entire world to educate on this, but I firmly believe it is fundamentally the answer to the question at hand.

How do we get better? It is a question applicable to planning, process, and results. Guide the injured to that question, and help them find the answer. Break the cycle of entitlement. It's as if their life depends on it.


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