Why Seek Mediation? WCI Panel Breaks Down Strategies, Misconceptions on Claims Handling Goals

Conference Recap

If you play word association around the phrase "mediation in workers' comp" you might have an idea that it's a starting point to getting a claim over and done with.

But a WCI panel featuring Scott Silver of Silver, Bass & Brams, P.A.; Michael Grimaldi of Travelers Insurance Company; Crystal Chancey of Publix; and Tiffany Elkins of Lodestar Claims and Risk Services advised that mediation presents and opportunity, not just a means to an end.

Resolution Thinking

"The biggest misconception is that settlement begins at mediation," Elkins said. "We should be approaching claims resolution strategically."

Grimaldi agreed, noting that acting early is the best strategy.

"We always want to apply resolution thinking to claims," he said. "As soon as the accident investigation is complete, we can begin thinking about resolution."

For Silver, such "resolution thinking" places significance on the investigation.

"It's not just our first opportunity to ask a question, it's our first opportunity to start asking questions," he said. "And use your gut, trust your gut if something doesn't seem right."

Keeping the Employee in Mind

The panel also highlighted that at the center of every claim is an injured worker, a person whom claims handlers must be thoughtful of and communicate with.

"It's easy to use templates, but were' trying to figure out employees' fears and psychosocial factors," Elkins said. "The injured workers is always going to set the vibe of a claim, so employers need to know how they can shape a claim."

Chancey said that being clear with expectations is a solid first step.

"Employees seek counsel because they are injured and they stop hearing from the employer," she said.

Grimaldi agreed and explained that employees need to feel that they aren't in the dark.

"Taking no action is not an option," he said. "Focus on the return-to-work piece because that's the best way to get the claim closed."

Teamwork

Getting to a successful claims outcome takes effort from a range of people, so the ability to work together goes a long way.

"It takes a teams mindset," Chancey said. "The best resolution equals getting someone back to preinjury work, and if that's not possible, it's looking into the next best outcome."

Grimaldi suggested making updates to the resolution plan every 90 days.

"Bring your doctors in," he said. "Physicians can give you insights as to where things are going to go; bring in all your stakeholders."

Elkins said that a team mentality can help a claims handler stay ahead of the work.

"Take a holistic approach," she said. "Be proactive throughout the claims process and answer questions before the arise."

Ultimately, according to Chancey, it's important to know what the goal is and what purpose drives claims work.

"Start with the end in mind," she said. "Handling claims is more than just a transactional process, so focus on the injured employee because we never want the injured employee to feel like they're just a transaction."

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