Legacy cases may be the bane of your existence. You might have a case in particular where you know the injured worker is frustrated with the workers’ compensation system — the scrutiny, the providers, the delays, the denials — and yet he shows no interest in settling. You know because the adjuster asks him every few months. And yet, his claim continues for years.
To settle these claims and get them off the books requires more than perfunctory communication; it involves putting yourself in the shoes of the injured worker — understanding his particular situation, his needs, and, especially his fears. Increasingly, workers’ compensation payers are using outside neutral third parties to do this, and they are helping to settle legacy claims in a manner that is a win-win for all parties involved.
Barriers to Settlement
There are myriad reasons injured workers won’t settle their claims, but the overarching one is fear of change and the responsibility of managing one’s own medical care. Some of the most difficult cases to settle are those where the injured worker needs the ongoing, future medical treatment.
Imagine your life suddenly turned upside down because of an injury. In addition to the pain you’re having, you are at the mercy of a complicated system you don’t understand. But after a while you become familiar with it enough to have some sense of security. You know your medical care will be taken care of, despite some denials of treatment and headaches that may come with the territory. You know you you’ll have some additional money coming in to help pay your living expenses and take care of your family. And you know that there is someone — the adjuster, case manager, or attorney — who communicates with you about your situation, even if it is infrequently, and only by email. At least there is someone with expertise helping you out. You know there is someone that can help you navigate the complicated healthcare and workers’ compensation maze.
Settling a claim means the injured worker is on his own; to find his own providers, buy his own medications, navigate Medicare issues if he is a beneficiary, and manage the settlement money to cover his medical treatments and ensure it won’t run out too soon. Many of these injured workers don’t want to settle because, as much as they may detest dealing with the workers’ compensation system, their anxiety over going it alone is stronger. Rightfully so, some of these injured workers have become creatures of habit, preferring the safety net of the workers’ compensation system as opposed to taking a perceived risk by settling the claim.
Fortunately, there are advocates available to guide these injured workers through the post settlement process, and at minimal cost to them. Professional administrators are outside and neutral organizations brought in specifically to work with the injured worker who has settled his claim.
Professional administrators act as facilitators during the settlement process, and are typically only paid if a case settles.
Administrators are care advocates post-settlement, working for the injured worker. That means they handle every aspect of medical care after settlement; from helping the injured worker maximize the settlement money through medical discounts and finding providers that are convenient and appealing to him, to handling the burden of Medicare reporting and protecting other government benefits that may affect the worker.
Having reached a settlement means the injured worker is free to see any medical provider he wants, and there is no utilization review or denials of treatment. Professional administrators with strong provider and pharmaceutical networks can offer discounted costs, saving money for the injured worker. The role of the professional administrator is to make sure the injured worker is using his settlement dollars appropriately, and to handle administrative burdens, which the injured worker would otherwise have to do. The goal is to help the injured worker move on with his life and be as productive as possible.