After The Shooting: Self-Funded Workers Comp & Advocacy-Based Claims Management

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San Bernardino County’s self-funded workers comp system was investigated following a 2015 mass shooting attack. Implementing advocacy-based claims management may better manage treatment for victims.

The December 2, 2015 mass shooting in San Bernardino, California, that left 14 dead all but destroyed the county’s Environmental Health Services Division, according to Ray Britain, the county division’s interim chief at the time of the attack. In addition, the performance of the county’s self-funded workers comp program has been scrutinized for more than two years.

Britain told the San Bernardino Sun in November 2018 that of the 114 employees working in the at the time of the shooting, about 15 are still working full time. He is now medically retired, though he returned to work the day after the attack and stayed until January 2016.

When I look back … I was operating on emotion after the event. I had an expectation that, ‘this happened at work, and we would be taken care of,’ ” he said. “It became very apparent that help was not to be provided, and we would be on our own,” he said.

Numerous employees, including Britain, have reported struggling with the county’s workers comp utilization program over treatment. His request for psychological treatment was initially denied, though approved one year later, according to the story. Another county employee and shooting victim was denied a post-surgery home-care nurse.

Many San Bernardino survivors said the workers’ compensation utilization review system delayed treatment. Some went before the California Senate Labor and Industrial Relations Committee to present their treatment denials and delays, and the program was investigated by the state.

Clarity, Speed & Reducing Complexity

The county was accused of not properly communicating workers comp processes to employees, according to an earlier Sun report.

A primary issue is recognizing the need to expedite getting workers affected by mass shootings into treatment for trauma akin to battlefield injuries.

The state investigation completed early in 2017 determined that improper paperwork submitted by doctors was at fault for denials or delays, The Sun reported.

“Often because (employees’) doctors had failed to document or fully explain their requests, employees who were still suffering and expected their doctors’ recommendations to be followed were frustrated by the denials,” wrote George Parisotto, acting administrative director for the state Division of Workers’ Compensation, in a letter accompanying the report, according to the county news release at the close of the investigation.

Doctors’ requests for treatment authorization sent to the county for approval were then sent to outside utilization review doctors. In December 2016, county supervisors expanded the use of outside case managers to expedite claims after establishing the Workers’ Comp Claim Expediter Reserve fund.

The county indicated approval of 90 percent of treatment requests. While 200 claims were denied, 94 were appealed with 22 overturned. The county denied psychological injury claims from 24 employees who weren’t present at the attack.

Urged by state legislators advocating for San Bernardino victims, the state of California passed a worker’s comp law in 2017 requiring a nurse case manager to be immediately assigned to an employee who is a victim of a terrorist attack in a declared state of emergency.

7 Steps to Advocacy-Based Claims Management

According to the Institute of WorkComp Professionals 2018 trend report, more employers will practice advocacy-based claims management, which takes commitment and consistency:

“Transparency, collaboration and communication are the techniques that dominate effective claims management today. By easing the minds of injured workers and helping guide the recovery process, employers can avoid adversarial relationships and obtain better outcomes.”

There are seven basic steps to implementing advocacy-based claims management that are worth taking, according Michael Stack, principal of Amaxx Risk Solutions, on the Reduce Your Workers Comp blog:

  1. Immediately address medical needs
  2. Communicate early, often and clearly
  3. Educate and inform
  4. Show compassion
  5. Use the terms “injured worker” and “advocate,” rather than “claimant” and “adjuster”
  6. Consider the worker’s whole life, not just bodily injuries
  7. Simplify the claims process

Injured workers who feel their employers actually care about them and are willing to work with them are more likely to feel empowered and valued.” he wrote.

Read more about workplace violence in our previous coverage:

Active Shooter Training for Work Spaces

 

About the author

Andrea Fox

Andrea Fox

Andrea Fox is Editor of EfficientGov.com and Senior Editor at Praetorian Digital. She is based in Massachusetts.