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Psychosocial Factors Show Rehab Nurses = Great Risk Mgmt

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WCRI’s Newest Study on Psychosocial Factors – My Take On Claims Management

WCRI (Workers Compensation Research Institute) recently released the results of their newest study on how psychosocial factors have a direct correlation to the outcome of Workers Comp claims.  They interviewed stakeholders in the Workers Comp claim process.  I decided to take a different angle – with the same conclusions.

photo of signund freud gym psychosocial factors
Wikimedia Commons – Peter Gugerell

 

I have written many times about the cost/benefit of using Field Case Managers (Rehab Nurses) on new Workers’ Compensation claims.  See the end of this article for a list of links to those articles and the link to the WCRI Study.

My rule was always-

If the injured employee was going to be out long enough to make the waiting period payable – usually 14 or 21 calendar days,  I recommended a limited Rehab Nurse assignment at a minimum.

Assessing Psychosocial Factors Is Not Spying

When reading over the initial Rehab Nurse reports, I always read what was going on with the injured worker’s life before the injury.  The Rehab Nurse would often meet the injured employee at their home.

Even if they met outside the home, the initial interviews almost always seemed to be a precursor to how the claim would progress when trying to return them to gainful employment.   The psychosocial factors caused me to modify my claims handling procedures away from the “one size fits all” approach.

An initial adjuster call and mailing the injured employee a claims packet does little to establish trust with their future claim developments.  WCRI’s groundbreaking studies where they interviewed injured employees after their return to work established one huge concept – TRUST.

If the injured employees TRUSTED their employer before the claim occurred, then the outcomes were much more positive.  I added that link to the list at the end of this article.

We all know that being injured at work turns an employee’s life upside down at the beginning of the claim.

The injured worker’s attorney would seldom interject their concern about retaining their client’s privacy.   I found an explanatory phone call to the attorney with a guarantee to cc: the attorney on all reports worked well.  Many states now require filing a form to apprise all parties that a Rehab Nurse was being assigned to the file.

List of links

Rehab Nurse -Second Most Seen Provider on WC Files 

Sixteen Suggestions When Hiring a Rehab Nurse 

Recent WCRI Study on Psychosocial Factors

2019 WCRI Injured Employee Interviews

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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