NCCI's Riveting Stories

At its annual conference, held last week in Orlando, the National Council on Compensation Insurance showed, for the first time in my memory, a short profile of workers who had sustained severe work injuries. I found the video, which ran less than five minutes, one of the most memorable experiences in decades of industry conferences.

https://www.ncci.com/Articles/Pages/AIS2019-Return-to-Work.aspx

One can numb oneself into accepting a low bar for case studies of how workers sustain and recover from their injury. At worst, they are a self-serving narrative in which the worker is basically a prop for some sponsor to advertise its prowess in claims management or medical care. This video was, at least for me, very different in intent and impact.

In part, the setting made it so. The NCCI is in a line of business which to the average American might look like solving number puzzles. Its primary work is helping its affiliates, who are insurers, to understand the cost of providing workers’ comp insurance. But what the NCCI team, led by Bill Donnell, did in this video was to bring into a hall of a thousand attendees the personal trials and aspirations of four of the most vulnerable individuals in the country. This is one of many signs that the NCCI is positioning itself into the mainstream of American society.

Stories, according to Paul Collier, can serve three functions. They tell us to whom we belong. They teach us morals. And they tell us how the world works.

I’m going to focus on one of the four brief stories, Travis is a mid-thirtyish man who was struck by a car and sustained a brain injury. Early in his recovery, it was not clear whether he would be able to walk again. The statistics say that one tenth of workers’ comp claims costs arise from vehicular-related accidents. Brain injuries often lead to family breakup and a long slide down into misery. 

Yet Travis surprisingly comes across to me as on the same journey as I am taking. His thoughtful and calm way of describing his past tribulations, with implications that they are not over, grabs my attention and respect. Though he may live a far corner in life away from me, in this video he sits in the same room. It is inconceivable that anyone could call him a claimant, much less a “loss.”

The video’s directors kept out of the video anyone who worked on Travis’ recovery – no reference to claims or medical management people. We know that to respond to a severe injury takes the entire village, not just those who work directly with the worker.  Everyone in the hall, even if they never meet an injured worker in their life, could sense that they belong somewhere on the same path as Travis.

The second function of a story is to illuminate moral behavior. Travis talks about his role a husband, father and provider.  He shows that he holds himself accountable to recover as far as he can. (Again, it is left unclear how much he has recovered, other than to show a photo of him standing.). He appears to be saying, in effect, that as society (workers’ compensation) came to his aid, he reciprocated by recovering as much as he could.  It is very easy to think of insurance as a lottery that imposes little or no ethical demands on the person receiving the benefits.  This did not appear to occur to Travis.

The story of the accountable individual is deeply ingrained in our culture. In Shakespeare’s play, Henry V, the young king, in disguise, talks with two soldiers on the eve of what looked to be a terrible battle. One laments that were he to die the king is to blame.  Henry responds that each is master of his own soul, and accountable for himself.

To suggest that injured workers are accountable for their own recovery may seem misanthropic and delusional. But there is a core truth in this, and not just for brain injured patients whose recovery is well known to be heavily influenced by their own degree of motivation. The word “compensation” is misleading. Workers’ comp is not an award. The goal of our system is to make injured workers whole.  The success of the system fundamentally depends on the commitment of recovering workers, and for that matter employers. It might be better were employees in some way engaged when their employer buys insurance.   

The third function of a story is to describe how the world works. With economy of speech and image that would draw praise from a poet, Travis' story describes key aspects of brain injury. Recovery predictions are uncertain. Family cohesion is extremely important. It is hard, was hard for his four-year-old son, to understand what brain injury means. Many injuries, even apparently light ones, can affect us for our lifetime. 

Another admirable thing about the video is that it makes no one into a hero. Go to the World War Two museum in New Orleans or to the Museum of the American Revolution in Philadelphia and you will see no glory. We get into thinking that we need to show unambiguous victory laps which make us better people. The NCCI’s video defies this false narrative. Every advance is in some part tentative, and in large part the result of a tremendous effort which weaves us together. Bravo for these vivid vignettes. Let’s have an encore.

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