Workers’ compensation claims occur on a regular basis, but howthe adjuster manages the case from the outset can often determinewhether the employee returns to work or becomes a client of Dowe,Sueum and Howe. Consider the following case study and see how smallbut important decisions throughout the process created an outcomein everyone’s best interests.

John, a machinist, arrives at work at 7:00 a.m., clocks in andmeets with his co-workers in the break room. Nothing unusual abouttoday, but he hasn’t begun to work yet either.

After donning his proper personal protective equipment, Johnturns on his machine and begins to mill the first of 50 or so partsslated for his production run that day. After completing the first30 parts, John removes a milled part, but as he begins to pull itfrom the chocks, a small piece of metal shaving rubs the topside ofhis long, ring and small fingers of his right hand.

As it ran through the machine, this last part left a ribbon ofmetal shaving the thickness of a razor blade just high enough torub the fingers of his hand. John was wearing his cotton workgloves and thought it couldn’t be more than a scratch. As he putsthe part down, he notices a wet feeling on the tips of his fingersand sees blood when he takes off his gloves.

He reports this to his supervisor, who calls his health andsafety executive (HSE) representative. While John washes his hand,his supervisor, Bill, gets bandages from the first aid kit. The HSErepresentative calls the adjusting firm that assists with theirinjured employees and Steve, an adjuster, is dispatched to thesite. It seems like a small cut into the fingers, a little deep,but just a very thin slice. John is bandaged and the adjusterarrives. There is no indication that this injury did not occur atthe jobsite in the course of John’s work duties.

Brief introductions are made and Steve asks John how he’sfeeling. John responds, “Okay. I cleaned it up and Bill bandaged meup pretty good.”

Steve then asks what happened and John describes the incident.Because of Steve’s experience, he knows there is a chance thatJohn’s injury may be more significant than just a superficial cut.Steve asks John to straighten out his fingers, but he cannot anddescribes some pain associated with attempting to move them asrequested. Based on Steve’s experience, he calls the doctor and thehand specialist, and reports to the doctor the nature of the injurywith a description of the range of motion that John cannot display.The doctor instructs Steve to bring John into his clinic.

Along the way, Steve outlines to John what will occur that day,answers any questions, and explains why he called Dr. Hinderling,an orthopedic hand specialist. Steve also called the drug screeningcompany and arranged to have a representative meet them at thedoctor’s office. While John and Steve fill out the administrativepaper work for the doctor, Steve presents and reviews a medicalauthorization form with John.

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After the examination, the doctor informs John that he actuallyhas severed the extensor tendon of the ring finger and slightlydamaged the same tendon of the small and long fingers of hisdominate right hand. After making the arrangements to have therepair to John’s hand completed, Steve has enough time to obtainJohn’s recorded statement (provided John is not on any narcoticpain medication). He also provides John with a wage and employmentauthorization.

Steve has completed the initial phase of the investigationfactually, compressed the time that John will be out of work bydirecting the medical care, and reduced any lost time as light ormodified duty as available. Dr. Hinderling understands theemotional and psychological well-being of the injured employee andis extremely cooperative about having John return to work in somecapacity, albeit with little use of his right hand.

Because Hinderling is eminently qualified, John is more thansatisfied with the physician chosen by the adjuster and agrees toselect Hinderling as his treating physician by signing a choice ofphysician form (if the state requires such a provision) at thefirst surgical follow up appointment. Surgery is performed that dayand John is on his way to recovery. He will likely reach maximumrecovery and return to full duties and be discharged from medicalcare in eight to 12 weeks.

Steve can return to the facility to interview witnesses todetermine other facts that may or may not lead to subrogationpossibilities or at a minimum work with the HSE department todevelop possible changes in procedure to lower the risk of asimilar event.

John returns to work, fully recovered and with no residualdisability. Because the authorizations have been signed, Steve canfully investigate any prior medical issues that might have animpact on the claim and any background information from prioremployers should that become necessary.

John is thrilled that as serious as the injury was, his companytreated him as a person and not a problem to manage, and used thenecessary means to have him seen by a competent specialistimmediately. He was able to return to work, continue on full payand not have reduced wage replacement through temporary totaldisability payments.

Steve’s involvement from the outset, his empathy for John, beingthere for him throughout the process, his experience inunderstanding John’s injury and having the authority to act on it,allowed John to perceive Steve as an advocate. At the same time,Steve had the ability as a licensed adjuster to investigate theclaim and the circumstances surrounding the injury.

Since Steve has met with the doctor previously and knows him,they can exchange information about the nature and extent of theinjury immediately, not three weeks later when the report and billare issued. Steve can ask the doctor questions related to John’sinjury and recovery, and gain feedback that is useful in gettingJohn back to work sooner, heading off any reluctance on John’s partabout returning to work even on a diminished capacity. Steve’sinvolvement can quickly identify any change in John’s attitude andadjustments can be made to bring the matter to a conclusion.

These are the common stories, especially when companies take theinitiative to set up a process that involves a professional outsidefield adjuster from the outset. The medical professionals havealready been put in place because the adjusting firm has developeda network of physicians in various specialties to address injuriesthat occur within the workplace. This often eliminates the need toinvolve more than one doctor, and the injured employee is almosttaken aback by the personal attention delivered to him to addresshis injury.

A real overall big picture analysis is better to determine thecost benefits associated with such an approach. John didn’t need togo to a doctor to get a referral to a specialist, and more thanlikely, eliminated a four or five-hour emergency room visit. If theE.R. could line up a surgeon that day, everyone is now at theirmercy. This deteriorates into not just a severed extensor tendon ofthe right ring finger, but before it’s over, John could developsome permanent issue that requires extensive therapy, more medicaltreatment and requires the carrier to schedule an independentmedical exam with a physician.

There is an increased possibility that the entire claim couldtransform John into a plaintiff as well as a permanent patientinstead of a productive member of society who can support hisfamily. In the second scenario, John loses his dignity, since thelawsuit could be a multi-year process, and the company loses anotherwise productive employee; trading him for an embitteredplaintiff for Dowe, Sueum and Howe.

Robert L. Judge is the founder of R. L. Judge &Associates, LLC, a claims investigation and risk managementfirm.