It's refreshing to hear the term patient advocacy used in the workers’ compensation industry. There was a time when the workers’ compensation system seemed more adversarial than supportive toward injured workers.
So, what does patient advocacy in workers’ compensation actually mean? In literal terms, it means “injured-worker supporter.” When the workers’ compensation system supports the injured worker, he or she is far less likely to seek an attorney and is more likely to return to work. That helps to keep claim costs lower.
Three steps need to be taken if patient advocacy is to occur. First, everyone involved in the claim process (employer, physician, claim representative, case manager, etc.) must have an unwavering focus on return-to-work. Second, trust must be developed with the injured worker. And third, all parties involved—especially the employer—must keep the injured worker engaged throughout the return-to-work process.
All medical and rehabilitative aspects of the post-injury process must occur with one end game in mind: keeping return- to-work clearly in the injured workers’ sights.
In most cases, it’s not a question of if injured workers are going back to work; it’s when. Injured workers might be afraid their employer may not want them back at work and wonder how they will provide for themselves and their loved ones. They may also worry about the injury keeping them from doing the activities they enjoy. Recent headlines underscore those fears:
• “Forty percent of Americans (are) only one missed paycheck away from poverty”- CBS News Money Watch 1/27/19
• “Most Americans don’t have savings to cover a $1,000 emergency”- CNBC 1/23/19
Most injured workers don’t want to lose time from work. Therefore, a system that demonstrates that recovery and returning to work are the primary focus is a system that addresses and overcomes the injured worker’s greatest concerns.
Building trust is paramount. Navigating the workers’ compensation system is most certainly unfamiliar territory for most injured workers.
Employers can earn trust immediately by reacting with compassion to a worker who reports an injury. When an employer believes the injury is real and reassures an injured worker that he or she is a valued member of the workforce, the employee is more likely to remain motivated to get back to work as soon as possible.
At the claim level, trust is developed when the claim representative clearly establishes the expectations— including injured worker rights and responsibilities—and then follows through. Trust is reinforced when indemnity checks arrive on time and the claim representative is responsive to questions or concerns.
At the case management level, trust is earned when the case manager offers an empathetic ear, clarifies medical treatment options, and coordinates travel arrangements or accelerates appointments. Trust is further solidified when nurse case managers attend medical appointments and remind the treating physician that transitional work is available.
Helping to make injured workers feel valued and an integral part of their recovery and return-to-work process is critically important. A weekly phone call, text message, or handwritten note from the employer showing concern and the desire to have the injured worker back to work as soon as he or she is able makes all the difference. It is essential that injured workers feel connected to their employer in a positive way from the time of injury until they return to work.
The late Bertram J. Black made the best argument for advocacy when he wrote, “To work is to be needed and to be needed is essential for life.” That philosophy is the essence of workers’ compensation insurance today.
The A.I.M. Mutual Insurance Companies and Windham Group provide exceptional care through patient advocacy and utilization review to facilitate a positive and rehabilitative return to work. Windham Group offers Job Fit Accommodation (JFA) which complements A.I.M. Mutual’s own Stay at Work/Return to WorkSM program.
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ABOUT THE AUTHOR
Sebastian Grasso is the co-founder, president, and CEO of Windham Group. Entering its 30th year in business, Windham Group is the premier case management and return-to-work company in the country. Windham Group has case managers from Maine to Florida and a network of work environment specialists across the continental United States.