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The Suffering Inside The Claim
By Maureen Kohl Bennington - March 17, 2010

We are all stressed out because of large caseloads.  We can’t put out enough fires in a day let alone make real progress towards resolving cases.  The phone rings constantly, emails pop up endlessly, paperwork grows exponentially.  The meetings, seminars, conferences, deadlines and just sheer craziness of our work day are exhausting.  Believe it or not, we are the lucky ones!

Imagine living the life of an injured worker for a day.  Pretend for a moment you have a back injury.  All back injuries are serious.  A simple sprain/strain, in the moment, is extremely painful.  Your first challenge is getting enough rest.  A peaceful night’s sleep no longer exists in your life.  Each change of position increases your pain level and finding a comfortable position for sleep is nearly impossible.  Your sleep is continually interrupted and you have to adapt to sleeping positions you would never have considered prior to your back injury.  Sleeping for three to four hours at a time is a dream……..

Then, the alarm signal blares, and it is time to begin your day.   Everything you do seems to make your back pain worse but you keep moving.  The world doesn’t stop just because you injured your back.  You manage to get yourself ready for the day.  Your family has to fend for themselves because the most you can do is take care of yourself at the moment.  Your top priority is taking medication in hopes that the edge will be taken off the pain.  Then your day can really begin. 

Maybe today you will find out whether your MRI has been approved.  It is nerve wracking wondering whether you have a herniated disc instead of a back strain.   All the material you have read indicates the sciatic pain that is causing numbness in your leg all the way to your toes is a more serious condition.  But there is nothing you can do to hasten the approval process.  The frustration and emotions you are experiencing seem to make the pain worse.  You don’t understand why you can’t go to the physician of your choice.  The on-going paperwork from the workers’ compensation carrier is very confusing.  Every time you call for clarification you receive a voicemail.  You have called the claims professional for three weeks and still have not spoken to a real person yet.  You wonder about retaining an attorney but everyone you share your story with tells you it’s a bad idea…  And, it seems, everyone has a workers’ compensation horror story to tell.  Your head is spinning from information overload and all you really know is that you hurt. 

Along with the pain, you worry.  Worrying becomes your job.  What will you do if you can’t return to work?  You don’t have any other skills.  Why oh why didn’t you continue your education when you had the opportunity to do so?  What will you tell your three children if you have to move because you can no longer afford your home on temporary total disability income?  What will you do if benefits end and your condition has not resolved?  Will your husband stay with you if you can’t return to work and he has to take on all the household and family responsibilities?  This just can’t possibly be how your life ends up after all the years of hard work you have contributed.  Who can you turn to that can actually help you through this process, help you get proper medical care, figure out return to work options and help you get your life back?   

You can turn to the claims professional!  You, the claims professional, must put yourself in the shoes of your injured claimant every day.  Sometimes that is hard……..After years in the industry, there are a percentage of injured workers that are not honest or ethical about the details of their injury or their condition.  Everyone who is a veteran in this industry knows that…..However, the majority of the injured are in pain and are very afraid about the potential consequences of the injury to their lives.  Always think about what they are going through and how frightening it must be.  Provide them the resources they need.  Return their phone calls promptly, practice patience in explaining the process, do your best to authorize services quickly and move treatment along for the injured worker.  Speak to the physician if necessary, many of them welcome your calls.  Work with the employer to return the injured worker to any type of work as soon as possible.  Do everything possible to give the injured worker back their life. 

It takes one second for an accident to occur that changes your life forever.  Realize that you could easily be one of the statistics and try to walk in your injured worker’s shoes every day.  Pay it forward, you never know when you might need a helping hand in the future……


Maureen Kohl Bennington, M.S., CCM, CDMS, CPUR, CRC, is a Workers’ Compensation Consultant.
She can be contacted at: 714-350-7952 and mbennington@buildingpeopleinc.com

 
 

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