From adversary to advocacy: the claims process

Advocacy-based claims models emerged as “buzz” in the industry in 2016. At its core is a focus on people. Employees respond better and take ownership when they become part of the claims process. It’s about caring for themselves and their co-workers.

While many employers recognize the value of employee involvement in claims processes, they often don’t connect the dots that it will have a long lasting impact on reducing costs. Lower litigation costs, speedier recovery at work, improved medical outcomes, shorter claim duration, and more productive employees lead to a healthier bottom line.

When an injury occurs, there’s a good chance that it is the employee’s first one. Even a minor injury can seem like a big deal because they have never dealt with the system before. Stress, confusion, anxiety, and frustration can lead to fear. And fear drives costs. The word “fear” or related words were in 84% of notes taken by workers’ comp claims adjusters for claims costing more than $100,000 according to a white paper by Lockton Cos. L.L.C.

With the traditional claims approach, it’s easy to understand how the employee feels they have fallen into an abyss, with no one there to help. The process can be intimidating and the language adversarial. Suddenly, they become “the claimant.” They don’t trust insurance companies based on what they’ve heard and this mistrust is quickly reinforced when they have to deal with the “claims examiner” and the “adjuster” who are “investigating” and “assessing” the claim. Missing is an expression of concern, a voice of empathy, and an open line of communications.

The advocacy-based claims model turns the process around. It focuses on the employee, helps them understand and navigate the process, provides information to help make decisions, makes access to benefits as simple and easy as possible, and builds trust. In effect, it treats the injured employee as a consumer.

While the structure of an advocacy-based claims model will vary with company size, type, and culture, there are common elements that are simple and easy to implement:

  1. Change the script. Don’t focus on how the claim will be investigated or all the insurance jargon. Begin with empathy, concern, and compassion. Let the employee know you will be there throughout the process and that the top priority is to get them back to work as soon as safely possible. Take the time to inform the employee of what to expect and when and who to contact with questions.
  2. Designate someone to contact the worker on a regular basis. Don’t rely on the insurance company to be the prime contact, designate a supervisor, risk manager, or HR representative to maintain contact throughout the claims process. Simple gestures such as get well cards, hand written notes, texts, and a visit to the hospital go a long way in reassuring the employee and building trust. Find out how you can advocate for them. There are many potential stumbling blocks along the continuum of care causing a claim to be snagged, slowed down, or stopped dead in its tracks. Some helpful questions: How are you feeling? How is the carrier doing? Are you getting your checks in a timely manner? Do you have transportation to your medical appointments? Have there been delays in getting your doctor appointments? How can we help you? And always remind them, “We’re looking forward to having you back.”
  3. Make medical care easy. Navigating the medical system is tough. And the system is still driven by a pay for service model, which encourages excessive procedures and inflates prices. Having the support of occupational doctors and therapists and a triage nurse, who share the same objective of improving the injured employee’s health for a recovery at work, eases the process.
  4. Recognize generational differences and make the process easy for everyone. Phone calls and snail mail just don’t cut it with Millenniums. A cumbersome process doesn’t work for anyone. Starbucks, which employs many young employees, now allows its workers to report an injury themselves immediately online or via a special phone line. The result has been less lag time in reporting injuries and no uptick in fraudulent claims.
  5. Don’t have a blanket approach. While one employee may respond well to several texts or phone calls in a week, another may find it disturbing and feel the employer does not trust them. Find a balance that works and set the right tone for maintaining communication.
  6. Engage in the recovery at work conversation early. Be sure the employee and the treating physician knows the options available and that the supervisor is on board. Be mindful of the employee’s situations and needs and show respect for the employee as a person. Throughout the process, discuss work capacities and restrictions and involve the employee in the process of establishing accommodations or alternative job functions, so that they engage in, rather than thwart, the recovery at work effort. Find out what they feel comfortable doing and what they are worried about.
  7. Handle denials differently. A denial is often the trigger for litigation. Let the employee know that the claim does not meet the definition of a compensable workplace injury and avoid the word denial. Do so with empathy and advise them of any other benefit options that could help.

While some of these are small gestures, they have a positive and long lasting impact. When employees receive emotional support and believe you care about them and doing all you can to help them recover, the claim is unlikely to spiral out of control.

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New report weighs in on marijuana’s health benefits – nearly 100 conclusions

A new report from the National Academies of Sciences, Engineering, and Medicine offers a rigorous review of scientific research published since 1999 about the health impacts of cannabis and cannabis-derived products – such as marijuana. It lays out substantial evidence that associates the use of cannabis with the development of psychoses and schizophrenia, but also provides studies that show its potential benefits, such as relief of chronic pain and chemotherapy-induced nausea. Other benefits include: improvement of multiple sclerosis spasticity, improvement of short-term sleep in patients with obstructive sleep apnea, fibromyalgia, chronic pain, and multiple sclerosis, potential improvement of anxiety symptoms, and increasing appetite and decreasing weight loss in patients with HIV and AIDS.

But it also points out potential risks: worsening of respiratory symptoms and more frequent bronchitis with long-term smoking, increase in motor vehicle accidents, low birth weight in offspring of maternal smoker, and higher risk of cannabis overdose in children in states where cannabis is legal.

The report also acknowledges that it has been difficult for researchers to do rigorous research on marijuana, partly because of the federal classification of it as a Schedule 1 substance.

Employer takeaway: This report demonstrates how much more needs to be done – many health questions remain to be answered by better research. The increased legal availability of cannabis products in many states and the uncertain legal landscape has complicated workplace policies. It’s prudent for employers to establish a clear policy and communicate it effectively to employees as well as stay abreast of all legal decisions and regulations in the states where they do business.

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Things you should know

DOL website has new section on worker misclassification

The DOL has compiled information on worker misclassification on a new section of its website.

Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) “Re- Review” process

In Calendar year 2017, CMS expects to update its existing re-review process to address situations where CMS has provided an approved amount, but settlement has not occurred and the medical care that supported the approved amount has changed substantially.

Workplace deaths up in 2015

According to the Department of Labor, 4,836 fatal work injuries were recorded in 2015, a slight increase from the 4,821 fatal injuries in 2014. 2,054 of these involved transportation incidents, with roadway incidents accounting for 26 percent of all fatal work injuries. Almost half of these fatalities involved some kind of tractor-trailer truck. The information includes U.S. workplace deaths resulting from traumatic events but does not include workers who die from long-term exposure to workplace hazards, such as toxic chemicals.

MSD checklists by industry

The Safety & Health Assessment & Research for Prevention Program at the Washington State Department of Labor & Industries has released six industry-specific checklists and summary reports aimed at helping employers identify risk factors that may contribute to work-related musculoskeletal disorders. The checklists are available for agriculture, construction, healthcare, manufacturing, services, and wholesale and retail trade.

US tops lists for days lost and highest costs of sleepy workers

Lack of sleep among U.S. workers results in an increased risk of death and the loss of 1.2 million working days per year, and costs the economy up to $411 billion annually, according to a new report from RAND Europe. Researchers said workers who increase their sleep duration to between six hours and seven hours per night could bring an additional $226.4 billion to the economy. The researchers recommended that employers understand the importance of sleep and promote it, create brighter workplaces, provide settings for naps, and discourage lengthy use of electronic devices after work.

FMCSA to establish database of CMV drivers who fail drug, alcohol tests

Commercial motor vehicle drivers who fail a drug and alcohol test will be listed on a national clearinghouse to be created by the Federal Motor Carrier Safety Administration (FMCSA), according to a final rule published Dec. 5. Motor carriers will need to search the system for information related to current and prospective employees who might have unresolved violations that prohibit them from driving. Employers and medical review officers also will be required to report information about drivers who test positive for drugs or alcohol, refuse to comply with drug and alcohol testing, or participate in the return-to-duty drug and alcohol rehabilitation process.

FMCSA to develop minimum training standards for entry-level CMV drivers

Entry-level commercial truck and bus drivers seeking a commercial driver’s license or select endorsements will soon face national minimum training requirements under a final rule. The new rule will apply to first-time CDL applicants; drivers seeking to upgrade their CDL to another classification; and drivers seeking an endorsement for hazardous materials, passenger or school bus operations for the first time.

Workplace weight loss programs lower health care costs, improve quality of life: study

People who participate in a weight management program at work experience lower health care costs and better quality of life, according to a study from the University of Nebraska Medical Center. Researchers examined data on 1,500 University of Minnesota workers who attended group meetings about weight management over a three-year period. Participants typically were older women who had a higher body mass index and were more likely to have a chronic disease. The average annual savings in health care costs was $876 per participant.


State News

Starting July 1, doctors who wish to repeatedly prescribe opioids to injured workers will have to subject the claim to a review process, according to an overview of the proposed workers’ compensation prescription drug formulary set to go into effect next summer.


A new rule requiring some Illinois employers to provide collateral for large-deductible workers compensation policies was approved. The rule implements Senate Bill 1805/Public Act 099-0369.


A new pilot program is aimed at helping injured workers get pain management treatment after settling workers’ compensation claim. The voluntary program is designed for individuals with settled cases, who are still being treated with opioids, but the insurance company seeks to stop payment for continued use of opioids.

New York

New health insurance reforms that went into effect Jan.1 and target the heroin and opioid epidemic require small and large group health plans, and individual plans, to cover inpatient treatment for New Yorkers suffering from opioid addiction.

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Legal Corner

Essential job functions must be proven

Camp v. Bi-Lo involved an employee who was a grocery stocker for 38 years in spite of a bad back. He worked the night shift and there was an informal agreement with two co-workers that they would help him with extremely heavy packages.

One night, the work was not complete because of the volume of heavy packages and the employee was ordered to have a medical exam. The doctor concluded the employee could lift 10 pounds all the time, 35 pounds frequently, but never more than 35 pounds. Although a job description was written in 2007 (almost 30 years after he was hired), neither he nor his coworkers had seen it. Bi-Lo argued lifting 60 pounds was an essential job function and told him to use up his sick leave days so he could to receive his salary until he turned 62 and was eligible for Social Security payments.

The employee filed both an ADA and age discrimination case. The district court granted summary judgment to Bi-Lo on both charges, but a 2-1 majority of the 6th Circuit overturned both rulings. The issue on appeal came down to whether heavy lifting was an essential job function; his supervisor and co-workers all testified that heavy lifting was only a very small part of the job. “There is no evidence in the record of what the job description was for “stock clerk” in 1974 when he was first hired. The workers on the third shift testified that they had never seen a job description for stock clerk before this litigation. It appears that Bi-Lo looked only to the job description to render its opinion that heavy lifting was an “essential function” of the stock clerk position.”

The majority also ruled that even if lifting 60 pounds was essential to the job, Bi-Lo failed to consider reasonable accommodations both generally, and in the form in which the co-workers had helped over the years.

Takeaway: This case emphasizes the importance of considering not just the written job description but what actually happens in the workplace. It also demonstrates why supervisors should be involved in termination decisions and the importance of understanding their viewpoint before a case goes to court.

Workers’ Compensation
Employers must protect workers from secondary asbestos exposure – California

Considering two cases, Haver v. BNSF Railway Co. and Kesner v. Pneumo Abex, LLC, the state Supreme Court ruled that employers have a duty to protect the families of employees from “take-home exposure” to harmful substances that its employees came into contact with at work.

Employer cannot compel employee to produce video of IME exam – Florida

In Medina v. American Airlines, the 1st District Court of Appeal ruled that an employer could not compel a worker to produce a videotape of an examination by an independent medical examiner because the videotape constituted a privileged work product. Overturning a ruling by a judge of compensation claims, the court noted that materials prepared in anticipation of trial are normally protected from compulsory disclosure.

Temp workers cannot sue employer’s client or employee of client for auto accident – Illinois

In Morales v. Herrera, two employees of a temporary agency were assigned to work for Radio Flyer. While passengers in a vehicle being driven by a Radio Flyer employee and traveling from one worksite to another, they were injured in an accident. They collected workers’ comp from the temp agency but sued Radio Flyer and its driver for negligence. The courts ruled that the injured employees were “borrowed employees” of Radio Flyer, so the Workers’ Compensation Act barred them from seeking additional payment from the company or their co-employee.

Volunteer work incidental to employment and compensable – Indiana

In John C. Morris v. Custom Kitchen & Baths, a general contractor performed volunteer work for his church and the Boy Scouts that often led to more work for his professional contracting business. While doing a volunteer project for the Boy Scouts, he fell from the roof of a storage shed and fractured his right leg, resulting in three separate surgeries. His sole proprietor’s workers’ comp carrier, the church’s liability carrier and the Boy Scouts’ insurance carrier all paid money on his behalf.

He then filed an application for adjustment of claim with the Indiana Worker’s Compensation Board but was denied because he had failed to meet his burden of showing that his injuries arose out of and occurred in the course of his employment. The decision was reversed by the Court of Appeals, which found he had demonstrated “a sufficient connection between his interests in improving his business by conducting community service projects and his sole proprietorship.”

Odd lot doctrine used to uphold PTD award – Nebraska

In Hostetler v. First State Bank, the Nebraska Court of Appeal upheld an award of permanent total disability benefits to a bank employee for her fall, injuring her coccyx and sacrum. Her doctor limited her to working no more than four hours per day since the job was sedentary.

The “odd-lot” doctrine provides that permanent total disability (PTD) benefits may be awarded to workers who are not completely incapacitated for work but are so handicapped that they will not be employed regularly in the labor market. Recognizing that the worker had been diligent in her use of pain alleviation techniques, a trial judge found her permanently and totally disabled under the odd-lot doctrine.

Entitlement to comp benefits end after settling civil suit – New York

In Shiner v. SUNY At Buffalo, a university employee was collecting comp benefits for post-traumatic stress and a neck injury after her supervisor allegedly groped her at a holiday party. She later filed a civil suit against the university and her supervisor, which was settled for $255,000. The comp carrier filed a petition asserting the injured employee was not entitled to benefits as of the date of the settlement because she had not obtained consent for the settlement, which is required for settlements of a third-party action. Although the settlement was with her employer, the intent of the law is to provide a carrier with reimbursement whenever a recovery is obtained in tort for the same injury that was a predicate for the payment of compensation benefits, according to the court.

Alternative suitable employment after work injury – North Carolina

In McKnight v. Lowe’s, a 31-year-old worker at Lowe’s, who had begun as a cashier and worked her way up to a manager, suffered an injury to her neck and shoulder and had permanent lifting restrictions. The company initiated vocational rehabilitation services, but she was unable to find employment and eventually she was offered a modified job as a cashier, which her doctor approved and which paid about $150 less per week than the manager’s job. She refused to return to the position, fearful it would require her to exceed her lifting restrictions.

Lowes then filed to terminate or suspend her workers’ compensation. This request was granted by the deputy commissioner and later the commissioner, but the appellate court vacated, arguing there had not been sufficient fact-finding. The employer had not shown the position offered actually existed in the labor market and did not constitute “make work and that other employers would hire for the same type of work.” The case was remanded back to the lower court for further findings.

Employer’s subrogation rights include medical expenses as well as indemnity benefits – Pennsylvania

In a close decision, Whitmoyer v. WCAB (Mountain Country Meats), the Commonwealth Court ruled that an employer’s subrogation rights against a worker’s third-party recovery include medical expenses as well as indemnity benefits. The worker had suffered an injury that resulted in the amputation of his right arm at the forearm and eventually settled his claim with a lump sum of $69,995 and a promise of ongoing medical care.

Five years later, the injured employee and his employer entered into a settlement with the third parties allegedly blamed for the accident for $300,000. After adjusting for legal costs and the lien owed to the employer, there was a balance of $189,416. The settlement agreement provided the employer could use this balance as a “credit against future workers’ compensation payable,” but Whitmover noted he did not believe it could be used to reimburse his employer for medical bills.

Thirteen years later, the employer filed a petition to modify the terms of the third-party settlement agreement and specifically allow for it to use the $189,416 for medical expenses. Whitmoyer argued that “future installments of compensation” could not include medical benefits since they are not paid in that fashion. Also, allowing a credit for future medical expenses would make the injured worker responsible for the remainder of the medical bill, something specifically precluded.

The courts disagreed and on a 4 – 3 decision, the Commonwealth Court noted, “an employer, innocent of negligence, is entitled to a subrogation credit up to the full amount of a claimant’s recovery.”

Injured worker doing unasked favor for employer entitled to benefits – Pennsylvania

In Grill v. Workers’ Compensation Appeal Board (U.S. Airways), the worker was at his job, on work time, and was helping his coworkers move a locker he brought from home to replace a battered one the employer had been using. No supervisor had authorized or was even aware of this project. While moving the locker, the worker suffered shaft fractures in his fourth and fifth metacarpals, which required surgical treatment.

When the claim was denied, a WCJ and the WCAB affirmed that the employee was not in the course and scope of employment. But the Commonwealth Court reversed, noting that while the employee was not performing his normal duties, the continuity of the employment was not broken nor did the action constitute abandonment. The actions of the injured worker were not for his personal benefit, nor the benefit of a coworker, and were undertaken with the honest attempt to benefit his employer; therefore, it was within the scope and course of employment.

PTD benefits for migraines approved in spite of AMA Guides – Tennessee

There was sharp disagreement in the medical evidence testimony presented in Patton v. Paris Henry Cnty. Med. Clinic. An X-ray technician contended her migraine headaches were triggered by exposure to chemicals at the medical clinic where she worked. The AMA Guides (6th edition), assigned only maximum five percent impairment for migraine headache conditions, but the trial court gave little weight to this and found the technician permanently and totally disabled. This was affirmed by the Special Workers’ Compensation Appeals Panel of the state Supreme Court.

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OSHA watch

Court denies preliminary injunction on new rules on drug testing, retaliation claims, and accident reporting

The Federal District Court has denied industry’s request to enjoin new rules on mandatory post-accident drug screenings and safety incentive programs, workplace retaliation, and requiring employers to post OSHA logs electronically. (see the article, OSHA’s revised recordkeeping rule in effect: are you ready?)

New rule stresses maintaining injury and illness records for five years

Effective Jan. 18, 2017, a new final rule clarifies that employers have a continuing obligation to make and maintain an accurate record of each recordable injury and illness for five years. The U.S. Circuit Court of Appeals rejected this position in 2012 and some still argue the continuing obligation does not exist, but it is a long-held agency stance.

Update to construction safety guidelines

Recommended Practices for Safety and Health Programs in Construction is an effort to help small and medium-sized construction businesses improve workplace safety. The practices are advisory and do not establish legal obligations.

Add worker safety and health to sustainability plans

A new white paper documenting a link between workplace safety and sustainability calls for safety to be fully integrated into sustainability initiatives.

Final rule for handling retaliation complaints in the automotive industry

A final rule establishing procedures and time frames for handling employee retaliation complaints under the Moving Ahead for Progress in the 21st Century Act (MAP-21) became effective Dec. 14, 2016.

Recent fines and awards


  • Four contractors, Southern Chills Inc., Capri Construction Corp., SB Painting & Waterproofing Inc., and Brothers Carpentry Corp., received eight citations when a worker died after falling through an unprotected floor opening while performing punch-list work at a housing development in Miami. Combined, the four contractors face $91,536 in penalties.


  • Molinee-based Deere & Co. has agreed to pay a former employee about $275,000 to settle complaints it violated the anti-retaliation provisions after terminating an employee who reported unsafe work conditions.
  • Just six weeks after a machine amputated a maintenance worker’s left hand at Kerry’s, Inc. Melrose Park bread products facility, the company reported a second worker’s right forearm suffered multiple fractures as he cleaned another machine. Proposed penalties are $86,942 for allowing employees to service machinery without isolating operating parts.
  • Spotted in a drive-by inspection, Joiner Sheet Metal & Roofing of Greenville faces fines of $61,721 for failing to provide fall protection.
  • JW Construction and Plastering faces fines of $80,741 for failure to provide gloves, goggles, fall protection and protection from silica hazards.


  • A Dudley packaging firm, Shield Packaging Co. Inc., and two temporary agencies, Leominster-based ASI Staffing Group Corp. and Worcester-based Southern Mass Staffing, face a total of $338,000 for failure to call 911 when a temporary employee was seriously injured and for not providing the required training.
  • An employee of Ned Stevens Gutter Cleaning and General Contracting fell nine feet from a garage roof in Lexington and the company is facing fines of $45,500 for lack of fall protection.


  • Inspected in response to an employee complaint, Ypsilanti automotive exhaust component manufacturer, Bosal Industries Georgia Inc., received 19 citations and faces fines of $265,600.
  • Warren-based Central Transport L.L.C. will pay $265,400 in penalties as a part of a settlement agreement that commits the company to improving forklift safety at more than 100 terminals in 26 states.


  • Berwald Roofing paid $113,200 and Mortenson Construction paid $34,300 in a settlement after an August 2015 fatality in which an employee fell from the roof of U.S. Bank Stadium.


  • A federal court order allowed investigators to respond to complaints of unsafe working conditions at a sheet metal manufacturing facility, Hammond Sheet Metal, which operates as Barrington Manufacturing Corp in El Dorado Springs. Proposed fines are $138,430 for more than a dozen alleged violations relating to chemical and machine hazards.

New York

  • A Queensbury manufacturer, RWS Manufacturing Inc., failed to verify that it corrected previous violations and faces penalties of $197,820 for failure to abate and new and reoccurring hazards.


  • A Plymouth Meeting contractor, Vanilson Da Silva, doing business as Real Contractors LLC, has been fined $87,000 after a compliance officer observed workers exposed to fall hazards.
  • The Doylestown campus of Universal Health Services, a behavioral health facility, was fined $36,701 for failing to protect workers from assaults by patients, among other issues.
  • The sexual assault of an employee of Epic Health Services resulted in a citation for failure to protect employees from workplace violence. Proposed fines are $98,000.


  • The death of a 51-year-old chemical technician at Crystal Finishing Systems Inc. in Mosinee results in fines of $171,169 for improper machine guarding, inadequate PPE, and failure to properly train workers.
  • Alliance Laundry Systems faces fines of $124,709 after a 65-year-old-employee’s right middle finger tip was amputated, the third employee who suffered an amputation in the past year.

Detailed descriptions of the citations above and other OSHA citations can be found here.

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HR Tip: Red flag for potential litigation – fear

When an injured worker mentions the word “fear” or a synonym to a claims adjuster, that claim is more likely to head to costly litigation, according to research by Lockton Cos. L.L.C. released in a white paper, “Leading with Empathy.”

According to the report, 84% of lost-time litigated claims that cost insurers and employers more than $100,000 saw “fear words” in adjuster notes. For claims costing more than $50,000, 75% of them had notes with similar wording. The research also noted a correlation between uncertainty in the claims process and the prevalence of attorney representation.

Authors of the white paper stated that “one of the most common cost drivers of workers’ compensation is a lack of communication… The average lost-time claims cost 3.5 times more when words such as ‘fear’ and ‘afraid’ are recorded in adjuster conversations.”

Employers can change the process by helping injured workers navigate the workers’ comp system, communicate regularly, and train managers in active listening and empathy. Identify and dispel misconceptions about the injury or care, fear of being fired or losing income,and worry about of future events.

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Award-winning employers’ successful workers’ comp strategies

Risk & Insurance’s Teddy Awards recognize excellence in workers’ compensation risk management that reduces the number and cost of injuries to workers in the for-profit and nonprofit sectors. This year’s winners include:

Hampton Roads Transit – a public transportation agency

Problem: driver accidents, passenger violence, and overexertion. Claims system had been doubling annually with little accountability built into it. There was a pressing need to change the safety perception among workers.

Solution: a complete overhaul of their workers’ compensation and safety programs.

  • Surveyed employees and learned they did not feel they could talk openly about safety issues.
  • Conducted meetings with safety departments, mechanics, supervisors and union representatives and, ultimately, created a task force. Established new policies and procedures, including safety videos, to reinforce the safety message. Trained supervisors how to communicate the safety message.
  • Marketed the light duty program to managers. Made managers aware of how light-duty works and the variety of positions available to them. For example, since the bus drivers know the routes, they could help with customer service.
  • Hosts an annual workers’ compensation open house with case managers, doctors and workers’ comp attorneys to show them the work environment and provide them with a binder of all positions, including a list of all the restrictions they can accommodate.
  • Saw a 98 percent decrease in lost-time claims frequency, a 94 percent decrease in average number of days lost per lost-time claim, a 48 percent decrease in frequency of injuries and a 78 percent decrease in total incurred costs per claim.


Harder Mechanical Contractors – a specialty mechanical contractor

Problem: injured workers were getting lost in the mix among their multiple locations without receiving the proper attention. Exposures include dangerous equipment and changing environments.


  • Involved workers to help create return-to-work duties. Performed a review involving the employees to help determine their employees’ skills that would match them to modified duty jobs. This helped to build trust and also helped the company better understand their workforce.
  • Used sparingly, employees write a letter to their families about their commitment to safety when the company sees indications of safety concerns.
  • Created an atmosphere of trust. Communicate openly to employees why it benefits them to remain on modified duty. Empower workers to stop work when they feel the environment has become unsafe.
  • Have logged 17 million hours without a lost-time claim.


Excela Health – health care network

Problem: Blood-borne pathogens, combative patients and lift injuries. Injured hospital workers were going to their co-workers in the emergency room for care.


  • Decreased use of emergency room for employee injuries that do not require emergency care. Created a nurse on-call program to replace the costly habit. This took a lot of time and effort to change behaviors, but has become the most cost-effective program.
  • De-escalated workplace violence through training. Created a video teaching mental mapping, using the run, hide, fight method, which is hard for healthcare workers, who want to stick around and care for people. Showed employees where they would run, where they would hide or what they would use to fight. This is made part of new-hire orientation and is also reinforced on a monthly basis to the entire workforce.
  • Started a continuous improvement focus on safety. The first thing employees discuss in their employee meetings is safety. Employees are empowered to address the safety problems immediately through a “just do it” form. Once the project has been completed to fix the safety concern, they communicate the solution company-wide. They measure results and have received over 3,000 safety suggestions.
  • Excela Health reduced workers’ comp claims costs by hundreds of thousands of dollars over the past eight years.


Target – major retailer and distributor

Problem: a company-wide reorganization in March 2015 left the risk management department with fewer team members, not utilizing its third-party vendors in the most efficient way, and broad safety and work comp challenges due to size and logistics.


  • Rebuild the expertise of the safety and workers’ comp team by cross-training so everyone had a well-rounded understanding of risks on both the retail and the distribution side. Made greater use of predictive analytics to streamline and expedite its processes. Dove deeper into claims data to pinpoint where injuries are happening.
  • Turned to professional associations like the American Society of Safety Engineers and the Minnesota Safety Council to stay updated on the latest guidelines and training.
  • Training programs for powered equipment were simplified and adjusted to allow trainers and supervisors to control when an employee is ready to be certified and move on to independent work.
  • Developed a formal advocacy-based program, The Workers’ Comp Assistance Center. A Center employee, not the claims adjuster, contacts injured employees to say we care and we’re there for them, to familiarize them with the workers’ comp process and answer questions. Return-to-work coordinators are another critical component of the advocacy approach, and the retailer’s return-to-work program is a differentiator in the industry.


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