The Human Element of Claims

07 Jun, 2021 Brian Allen


“You could have an absolute, perfectly done surgery, textbook, everyone’s high-fiving at the end of the case, ‘Boy, that couldn’t have gone better.’ You could have an absolute surgical success and have an absolute clinical failure, and that could be for many reasons.” What?  Perfect surgery … clinical failure? This is the nightmare scenario of many workers’ compensation claims.  The quote is from Dr. Christopher Hills of Jackson Hole, Wyoming. He is a distinguished orthopedic surgeon specializing in spine surgery and one of the key contributors to The Optimized Patient book. When the author, Harvey Warren, shared with me the experiences and information he – as a patient recovering from three spine surgeries – had curated in the book, I knew immediately that Harvey had identified a foundation for solving one of the most difficult issues in the workers’ compensation space – managing the human element of a claim.

The injured worker is the wild card in any recovery equation. There is no way to predict how any individual may react to a major injury or surgery. That gray area between discharge from the hospital and returning to work is a time when injured workers need information on managing their mental attitude, getting proper rest, eating nutritious food and getting beneficial activity.  Until the writing of The Optimized Patient book, that information either could not be found or was scattered across so many sources that an injured worker had no chance of learning about the recovery process. For years I have been hearing about claims that “go off the rails” and I was motivated to turn the book into a service that squarely addresses the problem – the vast majority of injured workers want to get better, they just don’t know how.

For the last fifteen months, many of us were thrown into a “work at home” environment. There have been many articles and stories told about people who missed the social connections, were lonely, or felt morose or depressed. That involved people who still crossed the hall and went to work, virtually, every day.  Imagine an injured worker, suddenly removed from the workplace due to an injury, but without the luxury or ability to do their job. Not only do they experience the social isolation from their work life, but they have the added concern about being able to pay their bills or return to the job that was providing for them and their families. And they are frequently bewildered about what they need to do to help themselves get better. This creates the wild card scenario, because every worker will react differently to their recovery circumstance.  And very few injured workers will know the best/right things they can do to aid in their own recovery. 

Optimized Outcome Solutions, LLC, in Salt Lake City, Utah, was created to help manage the “wild card” by guiding injured workers through their recovery process using a model of engagement, encouragement, education and accountability. Built on the “four pillars of recovery – mindset, nutrition, activity and rest”, the Optimized program delivers fifteen weeks of educational and motivational materials from celebrity educators and experts, provides delicious meal plans crafted from foods proven to aid healing, delivers a self-assessment tool for injured workers to track their own recovery process and interacts weekly with program participants on a personalized call to maintain that critical and caring human interaction. All designed to keep injured workers committed to and engaged in their own recovery. 

It is difficult to regulate human behavior, but we can and should innovate programs to manage the human element, the injured workers, in the recovery process. One Texas claims management program is already testing the service and helping us develop data points. Optimized Outcome Solutions is seeking other insurers and claims management organizations to pilot our service and join us in innovating an affordable, yet effective, solution to improve outcomes for injured workers. The overarching mission of Optimized Outcome Solutions is to help injured workers “get better faster and stay better longer”. We invite you to join us on this important voyage. 

By Brian Allen

Brian Allen is one of the founders of Optimized Outcome Solutions, LLC. For the past 18 years, he has been an influential voice in the workers’ compensation arena, working on legislative and regulatory policy focused on removing friction from the system and ensuring the best care for injured workers at a reasonable cost. Brian can be contacted at

Source: Sponsored Content from Optimized Outcome Solutions

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