Tag Archives: Claims Process

Change for Change’s Sake: What Real Change in Workers’ Comp Looks Like

Note: This is my 200th post, so I think you will find it to be one of the best articles I have written so far.

Every industry has its share of conferences, conventions and meetings around the country. The insurance and risk management industries, which includes the workers’ comp industry, is no exception.

In the early stage of my career, I worked for a small, retail insurance broker on New York’s Long Island, and the men in my company would attend the Risk and Insurance Management Society (RIMS) Conference every year.

I am sure they went there to learn about things other brokers were doing, make connections with insurance company executives, and workers’ comp service providers. But typically, these conferences allowed the participants to hang out with their buddies at the bar, and play a round or two of golf.

So I was mildly amused when I read an article posted today in The Workers’ Compensation Daily from Safety National Insurance Company, titled “It’s Time to Change Workers’ Compensation”.

The article discussed a recent meeting of the Harbor Health Systems 2015 MPN (Medical Provider Networks) Medical Directors, in which an executive from Sedgwick gave the keynote address. His address discussed the need for change in the approach to workers’ comp claims handling.

Harbor Health Systems is based in California, and through the writings of my fellow blogger, David De Paolo, and the personal experiences of two women I previously wrote about, “Ms. X” and “Ms. A”, the California workers’ comp system could use more than a keynote address to change the problems and abuses injured workers are receiving in that state.

FYI, Harbor Health Systems is a subsidiary of One Call Care Management, a company that for the past two years or so has been gobbling up smaller companies, especially in the pharmacy benefit management arena, as well as other smaller workers’ compensation service providers, and as Joe Paduda reported earlier this week, One Call Care Management has acquired an imaging company called MedFocus.

According to Joe, this acquisition consolidates One Call’s stranglehold on the market, so if this is the kind of change Mr. North of Sedgwick was referring to, then it is more of the same.

The article goes on to say that the role of a medical director is to be there to help injured workers to recover from their injuries and resume their lives. I believe “Ms. X” and “Ms. A” would beg to differ.

The article also goes on to say that for years, the workers’ comp medical networks have focused on two things: discount and proximity. They would send injured workers to the physician closest to the employer’s location who would agree to accept a discount on the treatment provided.

Over time, they realized this approach was flawed, and that they should identify the medical providers who produce the best outcomes and incentivize them to treat injured workers by compensating them fairly.

They are learning that when they find these superior physicians, they need to get out of their way and let them practice medicine. The rest of the article details how the industry needs to evolve in how they devote resources to claims, how to better explain the workers’ comp system and protections it provides, and to avail themselves of the opportunities the ACA provides to evolve the way medical care is delivered.

According to Mr. North, when it comes to change, there are three main categories of people:

  • Innovators – people who are truly creating change
  • Learners – people who take what innovators created and work to evolve it
  • Ignorers – people who are uncomfortable with change and have a tendency to ignore it as long as possible

He said that workers’ comp cannot evolve if they are unwilling to take risks and become innovators; otherwise change will not happen.

I agree with his analysis, and my posts have attested to that fact time and time again. Therefore using his categories, it is clear that I would be considered an innovator, since I have been advocating implementing medical travel into workers’ comp.

Workers’ comp needs to take risks, and medical travel affords them of one of those risks.

Yet, those who have derided my idea, or who have not paid any attention to what I am saying, are ignorers, and there may even be people who would see to it that medical travel never becomes part of workers’ comp.

So I would like to add a fourth category to this list. Call them defenders of the status quo, or preventers, or even saboteurs, if it ever got that far.

So what is this change Mr. North is talking about? Is it real change, or just change for the sake of change? And what does real change look like?

Real change is not keeping injured workers and the system locked in a padded cell, wrapped in a straitjacket.

Real change is not buying up smaller companies and cornering the market, so that the very idea of competition is tossed on the dustbin of history.

Real change is not doing the same things over and over again and expecting different results.

Real change is not being afraid to look outside of one’s comfort zone, and outside of one’s national borders at a time when your industry is facing challenges from the expansion of out-out legislation that threatens to destroy workers’ comp, rising medical costs, physician shortages, questions of the constitutionality of exclusive remedy, negative media reports, changes in technology and diversification, and other “seismic shifts”.

Real change is becoming a learner, and I am looking for learners to work with. Real change is being fearless and recognizing that Americans are not the only ones who are able to provide quality medical care.

Real change is going with the flow of change in the world today and joining the globalized world; otherwise you stagnate and die. Time is running out. Real change is possible, but you must go after it.

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I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

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Can Medical Tourism Relieve Stress in Workers’ Comp?

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That was the first thing that popped in my mind this afternoon when I read about a study in Australia that was first published in JAMA Psychiatry last week. That study, Relationship Between Stressfulness of Claiming for Injury Compensation and Long-term Recovery A Prospective Cohort Study, by Grant, O’Donnell, Spittal, Creamer, & Studdert was the subject of an article by Kathryn Doyle in Reuters Health. Robert Wilson was the person who brought the study to my attention when I received his “Bob’s Cluttered Desk” blog on WorkersCompensation.com’s Daily Report in my email this afternoon.

Both Doyle and Wilson’s articles, Stress of filing injury claims linked to poorer health later and Does Claims Stress Increase Disability? states that researchers at Stanford University found that the stress of filing a claim for an injury may actually increase the severity of the disability over the long term. A survey of accident victims found that stress often comes from confusion over the process, delays and related medical assessments. The researchers found, it was reported, that those who “were most stressed by filing a claim tended to have higher levels of disability years later”.

Doyle and Wilson both quoted David M. Studdert of Stanford as saying that, “The novelty of this study was to look within a group of claimants to test whether those who reported experiencing the most stress also had the slowest recoveries”. The researchers found they did, according to Studdert.

“A random selection of more than 1,000 patients hospitalized in Australia for injuries between 2004 and 2006. Six years later, 332 of the patients who had filed for workers’ compensation or another accident claim told the researchers how stressful the process had been.”

A third of the claimants, the study found, reported high stress form understanding the claims process and another third were stressed by delays in that process. A slightly smaller proportion, the study said, said repeated medical evaluations and concern for the amount of money they would receive were sources of stress.

Studdert and his fellow researchers made the point of recommending that programs such as workers’ compensation could be redesigned to respond faster and make it easier for patients to understand. I am relatively sure that had this study been conducted in the US, and with a cohort of native-born and foreign-born workers, the results might be somewhat the same. It is why I have repeatedly said in previous posts that having workers treated in home country or similar facilities where the language and culture are the same or nearly the same, would not only relieve much of the stress of filing a claim, but with dealing with the stress of surgery and recovery.

Doyle reported that negative attitudes from doctors, friends, family or colleagues, did not seem to be common sources of stress. People with the most stress tended to score higher on a disability scale and have higher levels of anxiety and depression, as well as lower quality of life, Doyle said the researchers reported in the JAMA Psychiatry paper.

David Studdert even said that, “While it’s intuitive that the compensation process is going to be stressful for some claimants, what is less clear is whether that stress has a substantial impact on recovery many years after the injury.” Studdert also said, “We were surprised by the size of the compensation effects on outcomes like level of disability and quality of life – they were fairly strong.”

Doyle also wrote that the researchers took into account that some patients seemed to be more vulnerable to stress from the start, they found that the link between claim stress and long-term recovery as similar but not as strong. Michele Sterling, who studies injuries and rehabilitation at the University of Queensland in Herston, Australia said, “There is much debate at the moment about the role of ‘systems,’ in this case ‘compensation systems’ on health outcomes. She was not involved with the study conducted by Stanford University.

Sterling went on to add that, “If it can be established which parts of the process causes stress and/or poor outcomes or recovery then the system could look at targeting these specific areas and improve them”. Finally, Sterling told Reuters Health that “Some insurance regulators are already trying to do this in some areas.”

It is interesting to note here that the study deals with severe injuries that required hospitalization. Whether they required surgery is not clear, but is probable. This is probably where medical tourism can play a role, because if the surgery is performed in a facility that treats medical tourism patients, and recovery can be made in serene and restful surroundings, then the level of stress of the patient would be that much more reduced, even if the process of filing a claim and going through the claims process is still stressful. That would certainly be true for patients suffering through harsh winters like the ones we are experiencing in much of the US this winter.

Robert Wilson’s take on this study is also interesting, at least to myself, since I was once involved with workers’ comp claims, and Auto No-Fault claims, and it was while I handled No-Fault claims that I encountered a claimant who exhibited extreme stress from having an accident with his limousine, which my company insured for Automobile insurance at the time.

This gentleman was from Egypt and was a Coptic Christian, whose job driving executives and business people in what are called, ‘black cars’, must have been stressful enough having to negotiate Manhattan traffic and hurried professionals. The fact that the accident occurred and he was unable to work as a result of it, caused him more stress, and by the time he came to our office to be examined by our medical expert, he broke down in tears right in front of my eyes.

Now I am someone who never wants to see anyone cry when they are hurt and cannot work, so before he saw our doctor, I spoke to the doctor and told him about this man. I appealed to the doctor out of human decency and out of our shared cultural heritage of caring for those who are suffering, since our culture has suffered a lot in our long history, but that is for another blogger to discuss. I cannot recall what the outcome of this man’s case was, as it was a long time ago, but I do hope that he found some solace in knowing that there were good people trying to help him.

Back to Robert Wilson.

Wilson was struck by the finding of the study where the respondents said that, “repeated medical evaluations and concern for the amount of money they would receive [Emphasis added by Wilson] were sources of stress.” Wilson reiterated something he has said many times, that people rarely ask how they can get better, but rather how much they will make.

Wilson believes that the system is not and was never designed to fully meet that goal. He says that the workers’ compensation industry needs a new identity and a focus on Return to Function. Some of the prescriptions he recommends are:

  • Changing the name of Workers’ Compensation to Workers’ Recovery, where recovery specialists would work with workers with the goal of restoring whatever function was possible to their lives.
  • Better communication, more clear explanations, and increased expectations for recovery can be instilled to those coming into the system

Finally, Wilson quoted from the source article about the study from Katherine Lippel, of the University of Ottawa , where she studies occupational health and safety law. Lippel said, “I think the point that needs to be made is that those managing these systems, insurers of workers’ compensation boards, or no-fault automobile compensation schemes, should realize that they are undermining their own mission of getting workers back on their feet if the process is unnecessarily stressful.”

Medical tourism cannot make the process of filing a claim or the claims process itself less stressful; that is the responsibility of the industry itself, the regulators of the system and the insurance companies that write the policies or the Third Party Administrators who handled the claims for the insurers or employers. What medical tourism can do, and should do, is to make the final stage of the claims process, surgery and recovery, as stress-less as possible, and to return the injured worker to a state of health similar to what they experienced before their injury. This would serve the medical tourism well and would win it many more supporters and more repeat customers.

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