Monday, November 14, 2011

How Someone Gets to Any Stage of Claims Matters More than What to Call Them

An interesting conversation has been running in the LinkedIn group, Work Comp Analysis Group, about what to call the subjects of workers' compensation claims - the people actually injured at work, or at least those who claim to have been injured.

What I observed from this conversation was that how one references THAT person depends largely upon the position one holds, for whom one works and the stage at which an injury is at any given point in time.

It seemed from the responses that when one works an insurance company litigation claim desk then they are all "claimants."

Others prefer not to use that term because it implies an entitlement mentality, so "injured worker" is the term of choice.

Still others, obviously working for a self insured employer, just call them "employees" because injured or not, they are still part of "the team."

And if one is part of the medical process then the term is "patient".

Then along comes West Palm Beach, FL claims consultant Margaret Spense who gets a first hand experience of going from injured to claimant, and tells the story on her most recent post on her blog.

If you don't know Margaret, she is the president of a claims and risk management company and has been a workers' compensation claims adjuster for many years in the past. In other words she is very experienced in matters of insurance claims and workers' compensation.

The ordeal that Margaret goes through is not work comp, but it is a claims ordeal regardless.

Following her injuries in a trip and fall on a public sidewalk that had been lifted by a nearby tree root, and sustaining serious injuries from a face first plant into the concrete, Margaret gets initial treatment and follow up care reveals that her injuries are worse that she previously thought.

Margaret is also a motivated person, stating because she is president of her company, if she doesn't work she doesn't get paid. Her interest is just to get back to work.

In her tale, she describes the uncaring initial contact, and how she went from an injured person to a claimant with a cause as various rules of good claims management get routinely broken by those responsible for providing communication and care.

She sums up the thought process thusly:

"Now, I’m feeling like I should become a represented claimant who will be out for vengeance in a nano minute. Guess what, I need to go back to the doctor. My years of experience gives me a good track record on how the body works, I need therapy to stop my hip from stiffening up and on day 7 I don’t have any idea who the insurance carrier is and I don’t know who’s going to pay my mounting medical bills. Why should my health insurance carrier pay for something they didn’t cause? Furthermore, as you all know I am a public speaker. I now have a scar on my face, a broken tooth and I look like death warmed over. Not the image that I need to project as the CEO or Keynote speaker. But no one is getting this message yet."

My guess is that someone eventually WILL get the message, but not until Margaret elevates her ordeal to the point that someone up the food chain of insurance claims takes notice - by then its too late.

Back to what we call people who get injured at work - if you're a concerned employer/carrier/TPA then regardless of an employee's current ability to provide service under your direction and assuming you have a good hire then that person is and will remain an "employee" with all the rights, title and responsibilities that entails.

If your organization lacks care, or if THAT person was not a good hire and lacks value to the organization, then status changes to claimant with all the rights, title and responsibilities that entails.

My point is that while it would be convenient to have a neutral term that could be used universally to describe the person who gets injured at work, reality defies such convention. Like all matters of life, each person's reality is different because of the experiences each brings to the table in interpreting events.

It matters how the injured person is referred to, but it matters more how THAT person gets to the reference point in shaping perceptions.workers compensation, work comp, injured worker

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