"Communication is everything."
It's a mantra that you commonly hear from motivational speakers, marriage counselors, and disabling adjusters.
Wait a sec... disabling adjusters?
What they do
Disabling adjusters manage claims that involve time-loss from work — typically, injured shoulders, backs, and joints. They also deal with permanent impairments that aren't severe enough to prevent a worker from doing most types of work (e.g., partial hearing loss).
Our disabling adjusters make sure that nothing falls through the cracks, advocating for both the worker and the employer, making sure that the worker gets the treatment necessary to recover from an on-the-job injury. The disabling adjuster ensures the treatment is appropriate for the nature of the injury and focused toward helping the worker to get back on the job quickly (with modified work if necessary).
The injured worker hears from the disabling adjuster within three days of acceptance of a claim. The adjuster asks when the worker's next appointment is and if he or she has returned to work. Often, the disabling adjuster guides injured workers through what could otherwise be a confusing or stressful process.
The disabling adjuster calls to follow up on such events as medical exams, requests for surgery, treatment issues, denials, reopening requests, changes in wage, and when it has been determined that the worker has attained maximum medical improvement, typically leading to closure of the claim. If the worker has chosen to retain legal counsel, the attorney may request that the disabling adjuster initiate contact with him or her rather than calling the worker directly.
The first 30 days
The way communication is handled during the first 30 days of a claim makes all the difference in its eventual cost, says SAIF disabling adjuster Steve Marik, who has seen his share of expensive claims.
"A little compassion goes a long way," says Marik. "Employers sometimes get stressed out and forget that their employees are eager to get back to business too. They would rather work than stay home."
Employers who advocate for their workers generally see shorter time-loss and less expensive claims, but some major expenses may not be avoidable. Medical costs in general are expensive, and some important diagnostic tools, such as MRI scans that range from $1,000 to $1,500, are sometimes necessary to objectively identify what is wrong with the worker so that reasonable and necessary treatment may begin right away.
Keeping lines open
Disabling adjuster Kristi Kaminski says that injured workers benefit from frequent calls to their disabling adjuster.
"Injured workers should call or email to tell us how their medical appointments are going,
and especially if they feel that something isn't going right. If they don't reach us at first, they should leave a voice mail, because we'll get back to them promptly."
If medical progress is not being made, the disabling adjuster will follow up with physicians, physical therapists, and other medical providers, to achieve faster, better results.
In some cases, disabling adjusters may refer the injured worker to the Injured Worker Ombudsman's office, a free service of Oregon's Department of Consumer and Business Services (DCBS) that advocates for injured workers by providing informal assistance in resolving problems or disputes. (The ombudsman representatives are not lawyers and do not provide legal advice, but are highly experienced workers' comp industry specialists.)
For Spanish-speaking injured workers, SAIF's Claims Division maintains a bilingual unit, and also has the capacity to work with injured workers who speak languages such as Russian, Vietnamese, and others through use of the AT&T Language Line, which provides secure translation services.
Helping both employer and worker
According to disabling adjuster Sherri Minkler, many employers don't know that they can tap into the Employer-At-Injury Program (EAIP), which is admini
stered by DCBS.
"Through EAIP, employers get support for designing and providing modified work for the injured worker," she says.
Minkler sometimes has to clear up misunderstandings about EAIP.
"Some employers have the impression that bringing an employee back on modified work will cost them money. What they don't know is that they also get partial wage reimbursement. Plus, the sooner a worker can get back on the job, even if it's modified duty, the sooner that employee can return to regular work. Returning to work is a form of rehabilitation that aids in the recovery process."