If you’ve read my previous posts, you know that I believe in strictly following the law and using evidence-based medicine throughout the workers’ compensation process. I recently attended the TDI/DWC conference and went to a lecture on a new idea for managing claim files called Whole Person Recovery Management. This approach prioritizes the well-being of the injured employee, which is a refreshing concept. As members of the work comp community, we all have a set of rules, regulations, and deadlines to follow, regardless of where we live. It’s crucial to comply with these requirements and follow adjudication decisions to ensure everything is completed correctly.
In order to achieve this goal, various industries such as cost containment, bill review, and case management have emerged. Judging by the number of exhibitors at the conference, there are many companies vying for the funds required to achieve this objective. It appears from my point of view, what has been overlooked in all of this is humanity required to address the fundamental issue, which is the teammate who has suffered an eligible injury. We should all be aware of the “Grand Bargain” that initiated this entire process. The fundamental principles of employer accountability, a no-fault system, provision of medical/death benefits, and wage compensation.
The current system that deals with workplace injuries often falls short in adequately addressing the needs of employees. Rather than solely focusing on returning employees to work, it is imperative to prioritize their overall health and well-being. This entails taking into account multiple factors that can impact their recovery, both physical and psychological. In a recent lecture titled “Establishing a Whole Person Recovery Mindset in Workers’ Compensation,” the speakers emphasized the significance of shifting our mindset regarding this issue. A recurrent theme was that not everything is as it seems.
It’s worth noting that not all health-related concerns should be dealt with through the compensation system. Nonetheless, it’s vital to initiate the process by establishing clear communication between the team members and the claim manager. This will ensure that the claim encompasses all the repercussions of the event, which should be the ultimate objective.
It’s evident that there’s a lot of disagreement and conflict in our system. In my opinion, both sides are at fault due to the large sums of money involved and the lack of attention given to peripheral issues. This problem can be encapsulated in the saying, “Where there’s a will, there are relatives.”
One way to reduce conflicts among teammates is to provide clear instructions about the process, what will be covered, and when. This helps everyone know what to expect.
It’s time to rethink how we handle the claim file process. Many regulatory agencies, carriers, and individuals are adopting a new mentality for better claims management. Instead of using terms like adjusters, examiners, or specialists to describe those involved in the process, there is a focus on adopting the Whole Person Recovery Management methodology. As described in a recent lecture, using Work Recovery Professionals could be the solution to achieving these goals.
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