By: Vernon Poland

Vernon Poland — Mon, 12 Jun 2023 13:54:10 +0000

Thank you, Claire, for shining light on topic that needs it. Disability rights expert, Richard Pimentel, has famously said that insurance companies should not give injured workers a nickel more than they are entitled to by law, but they also shouldn’t give them a nickel less. Because companies that are financially responsible for workers’ compensation claims are only legally responsible for medical costs, lost wages caused by the injury, and costs associated with permanent impairments, policies are often crafted to limit expenditures,as much as possible, to only those costs. This can often be short sighted since investing some funds into “advocacy” related expenditures – i.e. case management or additional rehabilitation services – can improve an injured worker’s functional outcomes and reduce overall claim costs.

I once had a case with a shoulder injury that was showing marginal post surgical improvements with PT. Since the max recommended number of PT sessions had been met, the payor wanted to put the injured worker at MMI and accept a higher impairment and associated settlement costs. We, however, saw that there was stillsome improvement occurring and convinced the payor source to continue therapy. We ultimately saw a significant breakthrough in funcionality. The permanent impairment went from significant to slight. The quaity of life for the injured worker was near pre-injury levels and the cost savings in settlement costs more than paid for the additional services. Advocacy based in educated “best practices” with the goal of optimal medical and functional outcomes is the only way to approach the management of work related injuries, from both an ethical and financial perspective.

Comments on: Strategic Alignment in Workers’ Compensation

By: Vernon Poland