By Simon Booth
How a conciliatory approach to Workers’ Compensation claims benefits you.
“If one party begins by evading the cooperative responsibility, the other may respond by retaliating. Retaliation prompts a similar response, setting off a series of mutual recriminations [which] tends to push parties toward…the trap of mutual conflict.”
Scott R. E. (1987) Conflict and Cooperation in Long-Term Contracts
I never thought that psychology would creep into what I do as an insurance broker. But when we look at managing Workers’ Compensation claims, everything is about psychology in that interaction.
For example, if the employer is not trying to support you straight off the bat, you’re going to retaliate to that. Then the worker is going to retaliate to that. So in layman’s terms, if you push me I will push you back.
And that’s what we see constantly when we look at workers.
However, a conciliatory approach at the start might have enabled people to get a more amicable and equitable resolution. Instead of that, it’s ‘I don’t trust you, I don’t believe you, this didn’t happen at work, you’re trying to take me for a ride’ and so on.
Put yourself in their shoes: if someone came and said these things to you, how would you respond? Would you want to go back and work at a company where they’ve said that they don’t trust you? Here are three key things to think about when looking for an optimal outcome in your worker’s compensation claim situation.
Perception of the employer
One of the things I think hurts us a lot in this industry and how we get resolution of claims is the perception of the employer. As a worker, if your employer is not treating you well, whether it’s before or after an injury, why would you want to go back there? Why would you want to help them out? And, more importantly, why would you want to trust them?
I’ve had stories where a company did a big safety report, but wouldn’t disclose it to the employees. They just said, “No it’s safe in there now — trust us.”
That doesn’t really instill trust on behalf of the employer.
A lot of employers get it wrong. A colleague of mine said that when he worked in liability and an employer called up and abused him, he was already siding with the worker. Because he could already go, ‘If this is how you’re talking to me, how are you talking to the worker?”
How you start to engage the insurer from the time we provide the claim form has a big impact on the outcome of liability. We’ve all seen claims that we didn’t think should be approved, get approved. Step back and think: how did you approach the insurer?
In another case, after being told on a number of occasions that a claim was going to be accepted, they called up the eligibility person and abused them when it was accepted.
What do you think the chances are of a positive outcome next time you want to dispute a claim? Do you think they’re likely to work with you if that’s your approach to them? More importantly, what do you think their perception of you as an employer and a place to work is?
Make the doctor’s job easier
Something that I like to remind people of is, the doctor doesn’t get paid as much to see your injured worker as he does to see the guy who’s got a cold and flu. So, he’s trying to get your injured worker in and out as quickly as possible.
And generally, an injured worker takes up more time than what the guy with the cold and flu does. So as an employer, we should call the doctors and let them know that we’re supportive and actually give them information that helps get the person back to work — even just a nice little letter that has a list of the jobs available — ‘Please tick what they can do’.
If we make their job easier and engage them, they’re going to be more likely to work with us. As an example, a person went to the doctor and didn’t go to their IME (insurance medical exam) because they were sick. We had the return to work coordinator stalking the doctor. He made about 20 phone calls to find out the exact time that he went. When he found out it was two hours after he was meant to go to the IME, he decided that the worker wasn’t sick.
Well, no, maybe that was the only time that he could get in to see the doctor that day.
What do you think the doctor was like the next time someone called to talk about that worker from that company? They don’t want to take that call. You’ve stalked that doctor all day — over something that wasn’t really that relevant, and the outcome is a doctor that wants to shut you out.
Be nice to claims people
Our lovely claims people have probably the most thankless jobs you’ll ever do. I’ve never been around when a claims person has had a phone call to say thank you very much — because generally they’re upsetting someone. Either the employer’s upset because they’ve accepted a claim or they’ve declined a claim and the worker’s upset. Or the worker’s not back at work so they’re talking to them about compliance and the worker’s upset. But they’re also not back at work so the employer’s still upset because the worker is not back at work.
So there’s not a lot of warm and fuzzy conversations that your claims people get. But if, when you’re talking to them, you can provide a little bit of dignity and respect and understand that the job they’re doing is quite difficult, maybe they’re going to want to take your phone call.
Back when I worked in rehab, I had my guilt pile. I’d get all my files out at the start of the day and I put them on the desk. And there’d be three or four phone calls I did not want to make because of the person I had to speak to — and they went to the bottom of the pile.
And if I didn’t get time to get through to those by the end of the day, well that was fine; I would take care of them tomorrow. At which point they went to the bottom of the pile again.
So if you’re a little aggressive towards your claims people, they’re probably not going to want to talk to you and they are probably not going to want to actually help you as much as they will the people who are helping them out.
So next time you have a claim, think about how you as an employer are engaging with your injured workers and the impact that might be having on your Workers’ Compensation outcomes.
Disclaimer: This article provides general advice and should not be considered legal advice or an insurance consultation. You should seek appropriate counsel for your own situation. In addition, this post is directed at people in Australia. If you are outside Australia, please be aware that the circumstances in your own country may be different.
