Tag Archives: corvel

Police Shooting Shows Gaps in Work Comp

Timely response and clear communication are critical for handling workers’ compensation claims. However, when it comes to gathering information, “timing” might be just as important as “timely.” A story out of Ft. Worth, TX highlights that the process needs to be a well-choreographed dance, or significant problems can arise.

Fort Worth Mayor Betsy Price publicly admonished CorVel Enterprise Comp for asking “inflammatory questions” of a police officer the morning after he was shot and seriously wounded in the line of duty.

The officer, a 19-year veteran of the Fort Worth Police Department, was shot in the abdomen while he and another officer responded to a mother’s 911 call asking for help with her son. The son, who was barricaded in a bedroom, opened the door and shot the officer. Both officers returned fire, killing him. The officer underwent surgery at Texas Health Harris Methodist Hospital.

Mayor Price, in a letter to CorVel, said the company’s workers’ compensation representative showed up at the hospital the morning after the shooting and proceeded to ask questions of the family, officers and hospital staff. The letter calls the questions “inflammatory” and criticizes the timing “as one of our police officers rests in a hospital bed recovering from gunshot wounds received last night.” The mayor is requesting CorVel CEO Gordon Clemons and his staff meet with her to “determine the facts and get to the bottom of this matter.” The company did not respond for the initial newspaper article and, as of this writing, still does not appear to have responded publicly.

I must state unequivocally that we do not know what questions were asked, or in what tone they were delivered. Clearly, however, people were upset by what they perceived to be an entirely inappropriate line of questioning, and people’s perceptions will be their reality. The questions might have been of a simple, by-the-book initial claims investigation nature. Given the emotionally charged atmosphere, however, I would suggest the timing was likely poor. Perhaps the best question that could be asked in that highly volatile 24-hour period should have been, “How can we help?” [Editor’s Note: It now appears that this question was, in fact, the point of the visit, but communication was poor. Here is a link to a followup column by the author. ]

This highlights such a critical issue for our industry. If there are two things workers’ comp is routinely criticized for, it is lack of timeliness and of communication. After all, we are the industry that invented the concept of “hurry up and wait.”

Under normal circumstances, having a workers’ comp representative present and involved within 24 hours would be a great thing – assuming, of course, that the representative did not make it a confrontational affair. Yet, somehow, an employee in this case has produced the opposite effect, angering an injured worker’s family, his associates and employer – the client responsible for paying the bills.

Perceptions can have lasting and damaging effects. Unfortunately for the workers’ compensation industry, perception is not something we spend a great deal of time worrying about.

We are a statutorily driven industry, going through the regulated processes day after day after day. It is sometimes easy to forget that there is a human being attached on the other side of that claim, and that our actions are continually creating perceptions about us and our trade. That lack of awareness on our part can lead to costly errors, and that may be exactly what has occurred in this case.

We do not have the full details; this is a one-sided story to date. What we do know is that something riled the mayor enough to write that letter and take the entire matter public.

In one way, her actions accent a positive point of the story, as they show an employer actively engaged in the welfare of an employee, as well as the management of his recovery. It is something we need to see far more of across the nation.

As for the CorVel employee involved, we do not know if the person was a competent employee just trying to perform the processes required of the job — or is living proof that a company is only as good as the biggest idiot on its payroll. It really doesn’t matter, as the perceptions of the one side are the only ones that are of concern at a public level.

Those perceptions tell us that proper timing may be more important than proper timeliness, and that showing compassion is essential. Sometimes, we can show compassion just through proper timing.

The C-Suite View on Employer Costs

An open mic session at the California Workers Comp & Risk Conference in Dana Point featured insurance industry leaders identifying emerging market trends that are important to employers in California. Panelists were: moderator Pamela Ferrandino, national practice leader at Willis North America; Bill Rabl, chief operating officer at ACE Risk Management; Robert Darby, president at Berkshire Hathaway Homestate and former chairman of WCIRB; Duane Hercules, president at Safety National; and Michele Tucker, vice president at CorVel.

The panelists indicated that their short-term outlook on rates was flat to slightly higher, but not as high as over the last couple of years. For first-dollar accounts (those with no deductible), competition is increasing because there are more carriers entering the California marketplace. For the self-insured and those with large deductibles, the rate tends to matter less than the amount of risk retained by the employer, because the goal of these loss-sensitive programs is for the carrier to only cover unusual claims such as catastrophic injuries.

Managing medical costs also continues to be a challenge. Opioids are still driving costs, so there must be an aggressive pharmacy management program in place. The industry is starting to see complications such as organ damage arise from opioid abuse. This could become a cost driver. Almost half the opioids in California are dispensed by physicians, so it may be necessary to address this issue legislatively, as other states have done.

Predictive analytics are becoming increasingly important in the workers’ compensation industry. Some third-party administrators (TPA)s and carriers are doing excellent work in using psychosocial questions to identify issues that could complicate claims handling and increase costs. This allows them to intervene and devote additional resources to these claims. Analytics are also useful in the pricing process to assist carriers in identifying accounts that are performing above and below average and trends related to them.

Municipalities face significant, long-tail impact from presumption claims (for diseases that have uncertain origins but that may be presumed to have been caused by an occupation). Defending against these claims is extremely difficult, and, once accepted, the claims have a tendency expand. Claims for high blood pressure can eventually morph into claims for advanced heart disease or a heart attack. In many municipalities, a large percentage of police officers and firefighters retire under presumption claims. There are currently bills sitting on the governor’s desk that would expand presumption laws in California, including one bill that would create presumptions for certain healthcare workers in the private sectors. If these bills are signed, they will increase California municipalities’ workers’ compensation costs even more.

Finally, panelists were asked what they expect the key issues will be three years from now. Panelists predicted that mobile technology and the ability to communicate with injured workers will advance through apps that help with early intervention. They also expect to see an increased focus on wellness to address co-morbidities. Finally, everyone anticipates that within three years we will be talking about yet another California workers’ compensation reform bill and the continued expansion of presumption laws.