Building Trust in Workers' Compensation

                               

The words trust and workers’ compensation do not necessarily go hand in hand when looking to the perception of our industry. This industry went from being created to help restore the lives of people who had been unfortunately injured while working, to creating a landscape which has showcased mistrust and profitability upon human suffering. We need to do something, now.  

While I have never personally worked for an organization who operates on known profitability of human suffering, I have witnessed behavioral patterns displayed by organizations and their employees that depict the exact downfall that has been showcased and displayed through multiple media. Countless measures have been taken and shown to the world through messaging in a multitude of ways. Social media has amplified this messaging and if we stare at ourselves in the mirror, the countless attorney ads are not necessarily wrong. They may be a little far-fetched at times, but there tends to be a small piece of truth in existence.   

The ongoing messaging with an ever-changing world creates countless noise. While personally creating groups and enhancing organizations to do the right thing, many of us have tried to build empathic teams to restore the livelihood of people. Regardless of these efforts, distrust is an innate feeling injured workers have once they have sustained an injury. How do we help transition this mistrust and feelings of disrespect into a trustful, impactful, and healing relationship for the most successful outcome?   

Pause for just a moment. Moving forward I need you to keep an open mind and check the "fraud radar" at the door. At the onset of an injury, we need to begin with assuming people have good intentions. Statistics show fraud at the injured worker level is from 1-2%, and soft fraud occurs 30-35% once an injured worker feels "jaded" by the employer or at the adjuster level. Remember, workers’ compensation is never a solution for poor hiring decisions. Assume good intentions and treat people with the golden rule. So simple, right? Then why is it so hard for some people, adjusters, organizations, and companies as a whole?  

We must start by building trust. As an adjuster, an employer, a strategic partner working with an injured worker, we must figure out how to build the relationship to collectively move forward for an optimal outcome. It is not only the right thing to do, operating with integrity and establishing trust through building relationships restores the livelihood of human beings… AND is fiscally responsible. Seriously. This is not rocket science here… if we treat people with respect and dignity in workers’ compensation, injured human beings return-to-work faster and medical treatment resolves quicker. Who would have thought?   

Where do we begin? TRUST. Trust has become the broken element in our industry. We must start changing this now to impact what comes next with the future ahead. There are three things to consider when focusing on building trust with an injured worker.  

  1. Build positive relationships and positive experiences as often as possible.   

It has been said that you are the average of the five people with whom you spend the most time and during a work injury, injured workers spend a lot of time working with their adjuster and nurse case manager. If you are an adjuster who is not spending time with your injured workers, think again. The time you put in with an injured worker can not only make all the difference in their claim, but the outcome is also significantly impacted.   

Think about it from this stance: You have an injured worker who arrives on your desk with an injury. The more upfront information you can provide in a CONSUMABLE way, the better the overall outcome. The better you are at commutation from benefits, medical treatment, the workers’ compensation process, and simply getting to know the human on the other end of this claim, the less time you will need to spend on the back end answering questions. And let us be brutally honest here, you should have done a better job with up front if you are continuing to answer questions throughout the process. Multiple media help too. Follow up in email, in writing, with a text message, being proactive in calling with further information or to check in. There are so many ways to enhance this bond and the experience an injured worker has in our space.  

How well of a communicator you are is directly impacted by how consumable the information is you provide to an injured worker. Do you check for understanding? Did you anticipate any questions the injured worker may encounter? Did you really do everything you could to help? Or did you sluff through questions and not care? Take a long, hard look in the mirror before taking the time to answer. You know. I know. The entire industry knows how the vast majority will respond to this… and that is where the momentum, willingness, and capacity to change come into play. We tend to operate in a do not tell memorandum even though states outline what an injured worker qualifies for from day one. Mileage is the best example to this. How many of us explain, anticipate, and help an injured worker recoup this on the front end? In my almost two decades of experience in this space … very few.  

 Pay attention to the demeanor, issues, and concerns of the injured worker. If you stay with an open mind and assume good intentions (as in understanding the injured worker is concerned about what is going to happen to their body, where their paycheck is going to come from next, and how their life will be impacted because of these factors that YOU now oversee…), your mindset and outlook can stay energetically positive. Your mindset determines a lot of the course of an injured worker’s experience. This has EVERYTHING to do with YOU and nothing to do with the system.   

Yes, the workers’ compensation system operates in a multitude of ways. We have 50 different states with 50 different jurisdictional regulations and yet many complaints that exist in this space come from misinformation, unreturned phone calls and a lack of consumable information being provided. Remember, each one of us can change this and it has nothing to do with the system. These are all controllable measures one simply must have enough self-awareness and care to realize they can change. Do you?  

How much negativity has been spread through the communication within our own space? From employers complaining about an employee who was injured on the job to claims adjusters complaining of malingerers (or those perceived as malingerers) …negativity breeds. Heaven forbid we try to understand things from the other side or the perspective of the injured human being on the other side of this equation. Add this into the external messaging pumped into our space and it is no surprise the lack of trust that currently exists.   

Assume you are injured on the job… Would you want you to handle your claim? Be treated the way you treat people? If you would not, now is the time to start the change.  

  • Stay informed with facts and listen to your feelings. 
  • Balance your perspective with concern for others. 
  • Resolve conflicts with brevity and clarity. 
  • Be honest with yourself and with your circle… are you the problem? What could you have handled differently? How do you make yourself the solution? 
  • Be honest. We could all do more. We can be different. The effort level is minimal to do so.  
  1. Educate the injured worker AND properly educate yourself.  

Use good judgement and focus on the expertise needed with whatever you are looking at to come to an informed decision. Educate the injured worker along this process. The injured worker does not have the same knowledge base, skill set, educational background, or experience you come to the table with, and this is where clear communication to alleviate fears of the unknown can make significant impact on the outcome of claim, as well as the relationship you have with the injured worker.   

Always explain the WHY. If you are going to send an injured worker for an Independent Medical Exam, why? Explain the process to the injured worker. If you are going to need to secure a second opinion, why? Denying a claim? Why? Walking an injured worker through the process educates, informs, and provides rationale for what is transpiring. This helps alleviate the feelings of mistrust by keeping all parties informed along the way.   

Verify you know the why as well, and that it creates sound logic. Many times, adjusters are handling multiple states. Sometimes, mistakes are made along the way confusing jurisdictions and misrepresenting statute. The better you are at understanding the why and being able to articulate it to the injured worker, the better this will go, and the process will be much smoother.   

Think of talking with a small child or with an older parent/grandparent. Be patient. Explain, check for understanding, and use simple terms. We have so many acronyms in the insurance space to begin with, it can be confusing. With the claims organizations I have been a part of, we have alleviated the use of the acronyms because it makes the language difficult to understand when speaking with or looking for an understanding greater than between an adjuster and their claims leader.   

Remember your purpose. Your purpose is to restore the livelihood of an injured human. If your insurance company or third-party carrier tells you otherwise… the ethics and integrity of the organization go against everything that this industry was created upon to help people during unforeseen times. I would LOVE to hear about this. Please call me.   

When these times occur and the ethics/integrity are questioned, look yourself in the mirror. Remember the facts of an injured worker’s claim and the circumstances that have brought to the table. Focus on knowledge, objective fact, and obtain the information needed to process the situation at hand.   

  • Focus on making good judgement.  
  • Take the time to be well-informed on the mechanism of injury and medical. 
  • Anticipate and respond quickly to problems. Proactivity is imperative!! 
  • Seek outside resources as necessary. 
  • Articulate the WHY.  
  1. Consistency is key!  

 Walk the walk. Talk the talk through consumable and helpful information. Do what you say you will do. If you state you will get back to an injured worker or you will follow up on a task within a specified amount of time, do it! Communicate you followed up on this and what transpired. Give appropriate timelines. If you are sending out a request for causation (first, double check which state you operate in to make sure this is needed), be realistic in the timeframe you will receive a response back.   

Leaders of adjusters, employers of injured workers, and attorneys very rarely hear complaints on over communication, seeking to understand, and being kind through tone/verbiage. In addition, these people also very rarely, if ever, hear complaints of payments being made on time, communication of when benefit checks have been issued, or mileage being paid proactively. Food for thought on these issues as they spark the most litigation in workers’ compensation.  

Discipline helps flex the consistency muscle. If you feel yourself heading down the negative talk, negative attitude towards an injured worker standpoint, catch this moment and pull yourself out. Awareness is the first step. We are always a few simple daily habits away from a completely different life...your outlook on adjusting can be impacted by simply changing your frame of reference. Show up for yourself. Be the change. Be kind to everyone you encounter. ENJOY what you do. You can make the lives of injured workers’ better every day you show up. So… show up as the best version of yourself!! You deserve it. And so do the injured workers’ you oversee throughout this process.   

  • Lead by example.  
  • Walk the talk. 
  • Do what you say you will do. 
  • Go above and beyond what needs to be done. 
  • Be kind. This could be you one day or a family member/friend.  

Dr. Claire Muselman is the Chief Risk Officer for Emory Industrial Services and a thought-leader in the workers’ compensation industry trying to change the space into a colorful world that services the needs of the people for which it was intended.  


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