DO BETTER FOLLOW-UP ON WORKERS COMPENSATION

Steven Cesare, Ph.D.

A business owner from Oregon called me the other day to discuss basic human resources issues (e.g., staffing, discipline, culture). As our conversation progressed, the topic of employee injuries came to the fore, with his mood turning sour quickly. Apparently five months ago, one of his employees complained of a leg injury, was sent to the clinic, was discharged, and told to stay at home, receive therapy, and wait to be re-examined prior to returning to work.

In an age plagued by incessant fraudulent workers compensation injuries, the intuitive business owner requested the workers compensation vendor do an investigation on the employee to verify the legitimacy of his claim. The workers compensation vendor accepted the assignment. In the meantime, the employee remained at home, waiting for his injured leg to heal. The trusting business owner, believing the workers compensation vendor would provide a status update on the investigation when completed, went along running the day-to-day operations of his company.

Finally, after several months had passed with no final report, the business owner called the workers compensation vendor to ask about the results of the investigation and its implications for the employee.

You know the answer.

The workers compensation vendor had long ago ruled the employee’s injury was not job related, thereby rendering the claim as denied.

The vendor had failed to inform the business owner of its investigation findings. A simple mistake, right?

Only an OG customer would expect timely service in exchange for tens of thousands of dollars per year, right?

Per protocol, the trusting business owner had dutifully kept the injured employee’s position open for several months, losing productivity, while paying his benefits. Of course, the workers compensation vendor was negligent by not informing the owner of the denied claim. In the old days, most of us expected something called customer service; in other words, someone would provide a service to us in return for our payment. Customer service is no longer assumed; it has been replaced by a self-paced relationship with many vendors, by which the customer typically must now prompt the vendor to complete the transaction.

This redefined relationship is becoming common with legal activities, insurance inquiries, medical concerns, information technology support teams, outsourced vehicle/equipment repair, and to a lesser extent materials suppliers. Instead of them informing us of current status, availability, or delays, it is now the customers who typically make the follow-up telephone call or e-mail to them seeking the obligatory update.

If this trend has not yet affected your vendor relationships, count yourself lucky, and continue to demand fair service, timely responsiveness, and professional rapport from all your business partners. My professional advice is to conduct consistent vendor audits. After all, you are paying them!

Rather than relying on instinctive trust, the Oregon business owner, like all of us, should have pre-scheduled ongoing monthly meetings between his Office Manager and the workers compensation vendor to address open claims, Loss Runs, timelines, adjustments to reserves, and any relevant circumstances. Oh, by the way, the vendor should be responsible for calling the customer or scheduling the zoom meeting; don’t invert the commercial equation where you are responsible for tracking down the vendor you already paid.

The Oregon business owner ended up terminating the employee, who knowingly deceived him by erroneously claiming that his injury was caused by an on-the-job activity when in fact it occurred on his own time. I also suggested the business owner terminate his policy with the workers compensation vendor for deceiving him into believing they would provide professional customer service to him.

If the tables were turned around, how long do you think the workers compensation vendor would provide continuous service to the business owner trusting that his delayed payment really was in the mail?

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