Making a personal connection with theinjured employee begins with the first conversation and continuesthroughout their recovery. (Photo: iStock)

When an employee is injured on thejob, there are multiple regulations, requirements, details andsteps for the organization, the employee and their medicalproviders to complete. It can be an overwhelmingprocess. Butat the heart of the claimis a person who is hurt andsuffering — an individual who may not know where to turn.

In recentyears, there has beena dynamic shift in the focus of workers'compensation claim philosophy. In the past,many employerswere interested in resolving claims as quickly and as economically as possible. The injuredwere often cynical and employerswere eager to avoidlitigation.

Today,however, employers are expressing more concernwith the well-being of their employees andare providing high-quality care to help make them wholeagain. Companies recognize thatemployees are their mostvaluable assets. As a result,claims and managed care solutions must focuson the end-to-end process and provide apersonal connection with the injured employee to ensure the best possible outcome.

Ironically, this dynamic change inphilosophy is proving successfulfor both the individual andthe employer. This holistic approach is keeping costs and the need forlitigation down while elevating theconsumer experience to a newlevel.

Related: The pathway to workplace injury healing andrecovery

It starts with the firstconversation

Making a personal connection with theinjured employee begins with the first conversation and continuesthroughout their recovery. It's safe to say,if a claim starts out well, it will typically endwell.

Imagine yourself as an injured worker.Worried, in discomfort and with a lot of questions. Where do youturn? This first point of contact iscritical. It's important that the claims teamis able to provide information, answers andcompassion so the individual feels that theyare in good hands right from the start.

An integrated managed care servicewill connect the injured worker directly with 24/7 access to a nurse triage program. Registered nurses can answerquestions, offer reassurance, and provide injury evaluation andcare instructions.

It's importantthat the representative setsthe proper tone for the claim. An empathetic voiceand active listener will provide confidence that the claimsmanager is here to help and is not simply looking to meetcompliance standards.

By building apositive relationship with the injured worker from theoutset, a better outcome is likely. The claims professional will gain a better understanding of the employee's individual needs and can help find appropriateresources to get them on the best path forrecovery sooner. Theemployee is more likely to follow through with submitting paperwork, providing necessary information andreturning callspromptly.

Related: Does lag time impact claim costs or is it a symptomof a broken system?

On the road to recovery

Each claim is as different as theindividual at stake and the path to a positive outcome must bepersonalized to meet individual needs. A well-integrated workers' compensation solutionwill providea wealth of experienced resources throughout the recovery process,including:

• Nurse casemanagers – experienced and caring medicalspecialists who can monitor andguide occupational injurycare and access guidelines to managetreatment utilization.
• Behavioral health support – to serve as a patient advocate andfoster a non-threatening, friendly,professional relationship. Through thissupport, additional personal concerns can be identifiedand addressed to help reduce the risk of litigation. It can alsohelp address barriers to returning theinjured employee to work, such as childcare issues or financialworries. These are all concerns that mayimpact the outcome.
• Return to work strategies –claims examiners,nurses and vocational specialists can provide immediate and continual return-to-work strategiesthat match the injured worker'sindividual claim circumstances. Vocational specialists canhelp when employees have extensiverestrictions and theemployer has little opportunity to offer modified duty. They canhelp shorten the duration of the claim or intervene when providers are not following evidence-basedguidelines related to returning towork.
• Surgery nurse services– to help injured employees facingsurgery to be better prepared physically and mentally, and toconfidently steer themselves toward a faster recovery.This innovative approach is designed to focusspecifically on the needs of patients dealing with surgery, whichhas historically been a significant driver of high-costclaims.
• Physicianadvisors –to support keydecisions that can significantly impact a claim. Theycan help ensure that the appropriate treatments areprovided based on the injury,enhance the utilization review process, and providemedical and pharmaceutical expertise to ensure clients and theirinjured employees continue on the right path to achieve the bestpossible outcomes. 
• Prescription drugmanagement –in an era of growing concern over the misuseof pain medications, pharmacy management programshelp control the use of narcotics,opioids or inappropriate drugs prescribed to treat work-relatedinjuries.

By offering anintegrated approach to claimsand managed care, employers can be proactive inengaging resources that help to expedite recovery.

Related: Workers' comp and pain management experts discussalternatives to opioids

Making use of technology

Technological advances are alsohelping to improve and expeditethe claims experience. Real-time connectivity allows examiners and nursesto streamline communications and quicklyexchange claimsinformation.

Through the use of self-service tools,employers can trackand analyze their claims information,access data about trends, run reports and more.At the same time,injured employees can viewdetails about their claim, updateinformation, access forms and take charge oftheir recovery experience all from thecomfort of their home or hospitalbed.

Such technology is enabling claims tobe processed more quickly and efficiently than ever before and withgreater transparency.

Caring counts

When employees are injured at work, itcan be an unsettling and stressful time. They may be feelinguncertain about their job, their ability to pay bills, their healthand their future. Doing the right thing in each case includesmaking sure the employee has access to the medical resources theyneed, listening to their concerns, showing compassion, and beingthere to assist at every turn. Supportive, collaborative servicefocused on the individual is good for bothemployers and employees and making well-being a priorityhas proven to be effective in improvingoutcomes and experience.

Related: 10 workers' compensation issues to watch in2019

Terri Riley is the SVP, managed care practices and clientservices at Sedgwick. She can be reached at [email protected].