Tuesday, October 18, 2011

Setting Expectations Early Lowers Costs

A recent experiment by a large grocery chain in California demonstrates that setting expectations for claimants that they will return to work quickly and with as little disability as possible positively impacts workers' compensation statistics.

William Zachry, vice president of risk management for Safeway Inc. told  attendees of the Association of Workers' Compensation Professionals 13th annual Workers' Compensation Conference in Sacramento on Friday that the company started an early intervention program to test whether poor coping skills were responsible for increases in workers' compensation costs despite a reduction in the number of injuries.

77 people who went through the pilot program in Northern California were told up front that the expectation was they would return to work without disability. To their surprise, all 77 returned to work with no litigation and even though one subject received back surgery.

Safeway worked with Kaiser Permanente and Dr. Melvin Belsky, the store's corporate workers' compensation medical director, to developed a questionnaire that helped identify workers who might have poor coping skills examining characteristics such as drug dependency, depression and anxiety to determine which injured workers would become chronic pain patients. 

The biggest indicator, according to Belsky, was when the claimed disability was not proportional to the type of injury.

Belksy expected about 10% of the injured workers would become chronic pain claimants accounting for about 75% of medical and indemnity payments. Though the sample is small, it is still significant that none of the test subjects did.

Belsky said a growing body of evidence has found a connection between adult health status and early childhood abuse and household dysfunction. Because people in this group didn't develop necessary skills for dealing with adversity, they need to be treated differently.

Treatment following the biopsychosocial model, that includes a mix of physical therapy, conditioning and cognitive behavioral therapy is sufficient to get these people back on the job, according to Belsky.

Dr. Steven Feinberg, chief medical officer of American Pain Solutions and an adjunct clinical professor at Stanford University School of Medicine, agreed with Belsky, noting that doctors are not taught biopsychosocial treatment skills in medical school.

I might add that our workers' compensation laws are set up to discourage biopsychosocial treatment. We reward on the basis of disability. We pay doctors on a procedure basis. Attorneys are compensated based on how much the injured worker is disabled. Treatment of interdependent psychosocial components risks new "body part" claims.

Safeway has the luxury of self-insurance, so it can engage in experiments such as the one described here. The lesson is that there is an art to claims management that goes well beyond time limits, fee schedules, and AOE/COE.
workers' compensation, work injury

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