Work Comp Lessons from an Injured Worker

Steve was a highly paid Union oil pipeliner in October 2015 when he was involved in a fiery truck crash as another driver drove through a stop sign. It took more than two hours for the “jaws of life” to extract him. A passerby held his hand while he was trapped, even calling his wife who was over 1000 miles away to let Steve tell her things he wanted her to know. During that time he thought he may have killed the other driver, so in those two hours he was dealing with both physical and psychological pain. To say the circumstances of his occupational injury were traumatic would be an understatement.

The financial impact: The two-thirds compensation rate with a state maximum did not come close to the $5000 per week income he had prior to the injury. While the benefits check was helpful, it did not come close to covering his expenses. Four months later, those checks ceased because of the cap on benefits. While “compensation” is ingrained in the name of the industry, he took a gigantic step back financially. It took him nine years to settle the claim, so for almost eight years he and his family had to make major adjustments to their lifestyle. Fortunately, his wife and four children were extremely supportive and accommodating.

The physical impact: He manages ongoing pain every day. He had to learn how to walk again. He balanced clarity and control when it came to his medications and other pain management regimes after a variety of surgeries and rehabilitation. The industry calls it MMI (maximum medical improvement) but he has had to find a way to work around limitations that did not exist prior to the accident. At a variety of points during his treatment, he felt like he did not have much to offer his family and community anymore because of his impairment.

The industry’s lesson: Regulations are mandatory. However, they may not be enough to truly restore that injured worker’s life to how it was before the injury or illness, regardless of the level of personal resilience they may have. Adopting a “whole person recovery” mindset will help work comp stakeholders identify issues beyond the letter of the law that will impact outcomes. Regulations or statutes are the minimum, not maximum, expectation.

Steve understands that fraud is real – he knows people who have filed multiple work comp claims – and has an impact on how injured workers can be perceived. He evolved from being offended (“they don’t believe me”) to anger (“how dare they”) to hopeless (“it takes too long; wheels of system turn so slow”) to acceptance (“not going to work again”). Steve also heard stories where the injured worker was treated unfairly, which helped shape his early expectations for how the system would treat him. That is quite a psychological and emotional journey on top of the physical recovery.

The industry’s lesson: Fraud is less than ten percent of all claims … and more work comp fraud is perpetrated by employers than employees. Give each injured worker the benefit of the doubt until proven otherwise. An unmistakably skeptical and cynical attitude will come through in conversations and e-Mails that increase anxiety and slows down the recovery process and increases the total cost of the claim.

In addition to what the industry can learn from Steve’s experience, he also has advice to share with injured workers:

• The recovery journey may be a long rollercoaster ride, but ultimately it will reach a conclusion. The system works, it may just take time. Be assertive but patient.
• Know your rights provided by the jurisdiction’s rules and hold the stakeholders accountable for compliance.
• Maintain high expectations but always be realistic.
• Do your part by embracing what the doctor, therapist, nurse case manager, and other involved clinicians recommend. And assume the claims adjuster is doing their best on your behalf.
• Life post-accident, especially in such a catastrophic case, will be different and it’s not the system’s fault.
• Workers’ compensation is not necessarily “great” but is better than the alternative of having no medical and financial help in the recovery process.

The above lessons come directly from someone who has admirably overcome extreme challenges to adapt to his new normal. Steve is an amazingly positive person who, through his perseverance, wants to make a difference with his story and insights. The industry needs to listen and adapt as well.