Can “talking the talk” hurt your workers compensation program?

April 2nd, 2004 by Julie Ferguson

It’s long been our contention that when there is bad blood between employers and employees over workers comp, the issue is often one of communication. It might be helpful if employers thought and spoke in terms of “injured workers” rather than the depersonalized “claimants.” Similarly, employers and insurers often speak in terms of “incidents,” an officious euphemism that can trivialize what are often painful and bloody human occurrences. Work injuries are generally referred to as “accidents” as if they were inevitable or an act of God rather than the preventable events that they generally are. It seems impossible to prevent “accidents,” but most reasonable people would agree that preventing workplace injuries would be a worthwhile goal, and with some effort, largely achievable.

Much of the language that we use in the industry comes from the business of insurance and, let’s face it, the insurer approach to workers compensation is coming almost entirely from the financial perspective. That may well be as it should be – it’s the insurer’s job to assess compensability, and if suspicious circumstances are present, it is their job to raise the questions.

But employers shouldn’t fall in the trap of reducing what is essentially a human event to a simple financial transaction. In our experience, when employers address the human event of a work injury, and do so fairly, consistently, and with a focus on the employee’s recovery and return to work, a better financial outcome ensues than when focusing on the money.

That’s why we don’t encourage employers to build their workers comp system around fraud. Indeed, there are some fraudulent employees — it would be naive to think otherwise. (And let’s not forget that there are fraudulent employers and providers, too). But building a management system around the bad egg results in a punitive system that punishes the majority for the sins of the few. People generally live up to expectations, so expectations are better set to high rather than low standards.

When we meet with an employer who identifies fraud as one of their primary workers comp issues, that is often a sign that we are dealing with an employer that has more problems than just a high workers comp bill. With some exceptions – as in states like California where the issues are systemic – a serious workers comp problem is often the he tip of an iceberg representing a host of festering employer-employee issues and problems; it is the symptom rather than the disease. Either that, or in some cases, poor experience can be racked up to simple ignorance — a fundamental lack of knowledge about what workers comp is, and the misguided notion that some outside party will solve problems that must be owned and addressed from within.

An employer must build a system of management controls at every intervention point on the spectrum: first and foremost, prevention — the injuries that don’t occur are the least expensive ones, both in human and financial terms; second, immediate and appropriate point-of-injury response in the event an injury should occur — what an employer does to respond in the first few hours can set the tone for the future trajectory of events; and finally, post-injury management — a focus on the employee’s recovery and return to work. Communication is at the very heart of such a system, and good communication might best start for employers with thinking in terms of “people” rather than “claimants.”