Managing lost workdays and medical costs with nurse triage

March 16, 2023

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On-the-job injuries present a variety of challenges for impacted employees and their employers.

In today’s podcast we are joined by Beth Burry, managing director, clinical programs and Jo Copeland, SVP design and strategy who discuss what clinical consultation nurse triage services offer the injured worker and the employer organization when unexpected incidents occur. They also weigh in on how nurse triage can support the claims handling process and the injured employee experience.

Listen to the full conversation on the podcast here.

Workplace safety: reducing injury risks for first-year employees

November 15, 2022

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By Lisa Orr, senior human factors consultant and Laura Oslund, senior risk services consultant

A core principle in risk services, one of the most effective ways to support employee safety and well-being and control workers’ compensation costs is to prevent on-the-job injuries from occurring in the first place. A population group that presents a significant challenge in this regard is first-year employees.

Multiple studies have shown (and Sedgwick’s book of business confirms) that about one-third of work-related injuries occur within the first year of starting a job. Statistics regarding the injury susceptibility of those in new roles have spiked over the past few decades, and very recent shifts in the workforce have exacerbated the issue. Employers seeking to protect employees and lower their total cost of risk should consider redoubling their safety efforts, with a particular focus on those new to the job.

New roles, new risks

The factors putting those new to a job at greatest risk of injury are a combination of physical and psychological. First, there is the question of physical fitness for the role. If a new employee has been out of work for some time or hasn’t performed the same kinds of tasks in a while, it will take their body time to get appropriately conditioned —leaving them susceptible to injury in the meantime. They also need to become accustomed to the demands of their new work facility, job responsibilities and equipment.

From a psychological standpoint, many join an organization and team wanting to make a good first impression. They are eager to do well and to show off what they can do. They sometimes cut corners in the interest of efficiency but sacrifice safety in the process. New employees may fear asking too many questions during the onboarding and orientation process, opting instead to do what they know rather than learning the standards and expectations of their new employer and role. For example, a forklift operator starting a new position might say they don’t need any training since they’ve been operating forklifts for years; however, different equipment and a different warehouse present new perils.

The makeup of today’s workforce puts employers and their employees at even greater risk. Increased workforce mobility — especially among younger workers — means people change jobs and fields more often, and organizations have higher percentages of first-year employees in their ranks. Further, the Great Resignation and labor shortages that emerged in the wake of the COVID pandemic have forced organizations to tap into new sources of talent. Employers desperate to fill open positions are hiring people and enlisting temporary/contract workers who may not have the education or work experience needed to perform jobs as safely and effectively as possible.

Safety recommendations for employers

There are many things organizations can do to mitigate the risks for first-year (and other) employees. Here are some suggestions:

  • Establish a strong safety culture: An emphasis on safe working behaviors should be embedded throughout organizational people practices and operating procedures. Safety standards and expectations — both enterprise-wise and location-specific — must be clearly documented and communicated, so those in new roles understand where not to take shortcuts and to instead err on the side of caution. It’s critical that management drive the safety culture, leading by example, reinforcing everyday practices and granting employees time for training. Workplace safety engagement should be personal, with a focus on caring for employees and enabling them to return home to their loved ones each day.
  • Start employees off on the right foot: It’s essential that safety-related messaging be included in orientation for new hires and those changing jobs within the organization. Employees benefit from strong collaboration between the HR team in charge of onboarding and those responsible for safety and on-the-job training, as well as clearly defined roles for each. It should be apparent to new employees how the organization defines success with regard to safety. And, as outlined above, even experienced professionals who say they don’t need to be trained should receive refreshers on safe use of the equipment they’ll be operating.
  • Focus on engagement: Don’t underestimate the connection between the mental, physical and social aspects of work. Research shows that engaged employees in positive work environments are less likely to get injured. In an effort to promote employee safety, many organizations adopted workplace yoga and stretching programs in recent years. Studies of these efforts haven’t directly linked them to injury prevention but have shown their contributions to teambuilding and engagement — which, in turn, support employee safety. Mentorship from an experienced colleague or manager with the applicable skillsets and commitment to safety further promotes employee engagement.
  • Consider the role of technology: Many associate technology with distractions that can lead to accidents (like texting while working or driving), but the tech space has a lot to offer when it comes to employee safety. Wearable devices, ranging from smartwatches that monitor biometrics to robotic exoskeletons that support body mechanics, can improve employee health and safety behaviors when implemented effectively. Technology also enhances and expands safety training options, through gamification, engaging interactivity, realistic simulations and more.
  • Strive for continuous improvement: Safety training is not a “one and done.” Employees need ongoing refreshers on the organization’s expectations and should be evaluated at various intervals via surveys, behavioral checks and other means to ensure the training works in practice. Diverse learning styles and fresh training methods should be incorporated in any safety initiative; many adults learners gain the most information from a “tell-show-do” approach.

People are the greatest asset to any organization. When it comes to protecting employees, organizations —whether they’re in a fast-moving industry, such as food service/hospitality, health care, construction or energy or in a slower-paced field — must always work toward enhancing safety and quickly bringing new employees into the fold of the culture. The stakes, especially for those in their first year on the job, are simply too high to ignore.

Learn more — read about Sedgwick’s risk services offerings, or contact Michael Dougherty, risk services manager, to explore how our experts can help to make your workplace safer

Expand your view at PIEF 2022

October 5, 2022

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by Shane O’Dea, head of strategic partnerships and programs, workers compensation

During the Personal Injury & Disability National Conference, an array of stakeholders across Australia will come together to discuss outcomes and industry best practices for the motor accident, workers compensation, disability and life insurance sectors. Our own experts will take part in a session about leveraging the power of influence to elevate claims program success. Here is a glimpse at what’s coming your way.

The power of influence: How trust can improve claims outcomes and experience

Kimberly George | October 11 at 2:50pm

Undoubtedly, workplace accidents and injuries disrupt lives. However, the path toward resolution doesn’t have to be unsettling. Where a convoluted and complex claims process can further aggravate uncertainties, a well-managed, curated process can ensure return to work is seamless as possible. With an advocacy approach, an individual is engaged each step along the way and surrounded by the resources they need. Trust makes all the difference; with mutual understanding, transparent communication and supportive technology, recovery timeframes are agreed upon, delays are reduced and claims costs are kept under control.

Leading organisations are learning how to leverage the power of influence to aid the injured worker’s recovery and streamline the claims process. This begins with building trust, increasing engagement, and taking an advocacy approach that places the injured worker’s needs at the center of the process. Attendees will walk away from this session with an understanding of:

  • The practical, proven communication strategies that engage all stakeholders, including employers, doctors and injured workers.
  • How technology can support an advocacy model and encourage positive relationships in the claims process.
  • How a people first, tech forward and data driven strategy translates into a more positive experience for injured employees and improved outcomes for their organisations.

Opportunities to expand your view

Throughout the conference, Sedgwick leaders will lead panel discussions about workers compensation and international perspective and partnership. Tune in October 11 at 3:40pm to hear from Shane O’Dea and October 12 at 3:10pm for another chance to learn from Kimberly George. Countless individuals and teams across Australia have developed or implemented innovative solutions — enabling their organisation to provide new or improved services for people with an injury or disability, their employer or other appropriate stakeholders. To celebrate and showcase recent achievements, Sedgwick will sponsor the innovation in injury and disability management award. Kimberly George will present the winner at the Gala Conference dinner.

We’ll see you at the conference, but in the meantime…

  • Catch up on the edge magazine articles.
  • Follow Sedgwick on LinkedInTwitter and Instagram for live updates.
  • Search #PIEF2022 to explore what’s trending on social media the week of the conference.

Every step of the way, we’re here to help you embrace, elevate and expand your view. See you soon, Brisbane!

All eyes on workers compensation — and a look at what’s next

September 20, 2022

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By Shane O’Dea, head of strategic partnerships and programs, workers compensation

As David Stills wrote in a previous blog, workers compensation is comprised of multiple state systems across the U.S., each with their own unique set of rules and regulations that are in constant flux.

The environment is relatively similar in Australian, New Zealand and Canadian and flags opportunities to learn and partner across geographies. The definition of compensability is continually evolving, and benefits are constantly changing — as are the needs and expectations of the injured workers and companies.

The Workers’ Compensation Institute (WCI) recently hosted their annual workers compensation educational conference where the industry exchanged ideas about how to improve workers compensation systems and the injured employee experience. As in years past, Sedgwick was an active participant — sharing some of the industry’s most advanced solutions and concepts within the workers compensation arena.

Not surprisingly, there was a packed house for the keynote about the battle for talent hosted by Sedgwick’s own Kimberly George and Safety National’s Mark Walls. This theme is resonating across international borders and is front of mind in Australia. Further, it will be a hot topic for discussion at PIEF, the Personal Injury and Disability National Conference in Brisbane, Australia October 10-12, 2022. Kimberly George will participate as both a presenter and panellist on the theme international perspectives and partnership.

When we work together under unique circumstances, the industry is stronger, and the injured worker experience is improved. This directly translates to the sector in Australia and sets the stage for the upcoming PIEF conference — with ongoing collaboration across the industry.

WCI recap

Examining medical care advancements for today’s injured worker

The medical care and recovery environment of an injured worker largely determines the outcome of a workers compensation claim. Effectiveness is driven by how quickly care is administered and the appropriateness of the treatment that is provided. Greater emphasis is being placed on providing more holistic treatment of an injured worker. The introduction of behavioural health specialists, pain specialists, and surgery nurses are being more widely adopted and embraced to improve experience and outcomes. Telehealth is making medical follow-up more convenient and increasing adherence to prescribed treatment plans. The importance of medical literacy is becoming better understood and there are increasing communications around treatment options, pre-existing conditions, current medications, and other factors that can impact recovery. When quality medical care is rendered, an injured worker is better able to focus on healing, recovery, and returning to an active and productive lifestyle.

Looking at ways to streamline the claims process to optimize outcomes and experience

A claims strategy with a strong employee focus is paramount in today’s competitive business environment. Impressions are formed at the time an incident is reported and continue throughout the recovery and return to work process. Individuals will note the urgency, compassion, and concern expressed in response to their injury, the communication and guidance they are provided throughout the claims process, and the degree to which a fair and equitable settlement is established. Employers must ensure their culture and brand are manifested in all aspects of the workers compensation process, particularly in their interactions with employees.

Focusing on data patterns, emerging trends, and specialty research to mirror future impact

Well-known industry specialists shared highlights from their in-depth analyses and research related to areas having a notable impact on workers compensation, including a highly acclaimed chief data officer sharing patterns detected in data and what these can indicate about future litigation and trends emerging from California research that relate to access to care and what they may mean for workers and businesses across the rest of the country. Data patterns, emerging trends, and specialty research of this magnitude are as close as it gets to mirroring future happenings.

The themes for Australian jurisdictions are well aligned with the challenges and opportunities for schemes and the array of sessions at the PIEF conference will continue the momentum.

To learn more, visit our website or contact [email protected]. Every step of the way, we’re here to help you embrace, elevate and expand your view. See you soon, Brisbane!

Chiropractic care in workers’ compensation

September 12, 2022

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By David Kessler, D.C., M.H.A. CHCQM, SVP and medical director, Sedgwick Managed Care Ohio (MCO)

The Workers’ Compensation Research Institute (WCRI) recently published the findings of its study on the use of chiropractic care to treat injured workers in the United States suffering from lower back pain.

As a chiropractor by training and a longtime practitioner in the Ohio workers’ compensation and managed care arena, I was intrigued by this publication. The findings themselves are quite interesting and signal that further research on today’s physical medicine landscape is well warranted; however, their primary significance is, in my mind, to highlight the renewed role of chiropractic care in workers’ compensation.

The researchers found that average per-claim costs — both medical and indemnity — for low-back pain incurred on the job were lower for those treated exclusively by chiropractors, rather than other clinical specialists. Further, the injured workers studied who were treated exclusively by chiropractors were significantly less likely to be prescribed opioid drugs or to receive diagnostic imaging scans. (For detailed findings, refer to the study report.)

History and context

The 1990s were marked by rapidly rising healthcare costs. This spike, of course, strained workers’ compensation systems across the U.S. Multiple studies conducted during that decade found that chiropractic utilization was a significant driver of workers’ compensation healthcare spending — leaving many questioning its cost-effectiveness. This skepticism led a number of states to implement workers’ comp policy reforms and cost control measures limiting the use of chiropractic care in favor of other treatments viewed as more evidence-based and economical.

The results of the recent WCRI paint a far more encouraging picture of chiropractic care for injured workers than the findings of the 90s-era research.

What changed?

I believe there are a few factors contributing to the disparate findings.

  • Patient empowerment: Historically, patients remained under chiropractors’ care for extended periods, and progress toward recovery was dependent on adjustments or manipulation administered in the office. (The traditionally prolonged duration of chiropractic treatment and cost increases that began in the ‘90s are other reasons why it fell out of favor.) Today’s outcomes-based chiropractor focuses more on evidence-based guidelines and structured treatment plans with functional goals that ultimately transition patients to self-care in order to hasten improvement and alleviate reliance on in-office care. They educate injured workers on stretching and strengthening exercises to perform at home, as well as strategies for safe return to work and prevention of further strain, such as appropriate biomechanics and lifting techniques.
  • Continuing education: Many chiropractors now undertake training in complementary specialties and treatment approaches, such as sports injury management, orthopedics, neurology and more. This enables outcomes-based practitioners to leverage the knowledge and practices of other areas in physical medicine, as well as interdisciplinary care plans, and offers them additional tools to help injured workers achieve relief from back pain and greater productivity.
  • Multidisciplinary care: Although the recent WCRI study primarily highlighted injured workers treated exclusively by chiropractors, some of the greatest successes I’ve seen of late were in complex cases that warranted an integrated model of care when patients did not achieve the anticipated evidence-based recovery measures after chiropractic treatment alone. There is a burgeoning trend of multidisciplinary clinics opening to treat high-severity musculoskeletal issues — where orthopedists, family physicians, nurse practitioners, neurologists, physical therapists, chiropractors, massage therapists, surgeons and other specialists work together to deliver holistic care under one roof. Rather than presuming that any one specialty has all the answers for a given individual, this integrated approach covers a variety of treatment protocols and allows for quality, collaborative care for complex injuries. However, enlisting multiple practitioners can increase the medical costs on a claim, so it should be done prudently and only when warranted by the severity and complexity of the case.

Opportunities in the WC arena

Many in the workers’ compensation, managed care and employer arena still hold onto longstanding perceptions of chiropractors as providing care for extended durations without evidence of measurable or functional benefits. As a result, they tend to shy away from including chiropractic care in injured workers’ treatment plans, for fear of increasing medical costs with little return on investment and potentially extending lost work time. While some continue to distrust the effectiveness of chiropractic treatment, millions of people achieve healing and pain relief under the care of evidence-based chiropractors. (The WCRI study pointed out that individuals with non-occupational back injuries are much more likely to seek chiropractic care than those injured on the job.)

In light of escalating concerns over addictive pain medications, long-term side effects and rising pharmacy and surgery costs, chiropractic care offers a non-invasive way to help injured workers improve their quality of life and their productivity. Some people respond well to chiropractic treatment, others may not, and particularly complex cases may require multiple treatment approaches. However, chiropractic intervention is an overall low-risk and comparatively low-cost treatment option that merits further consideration.

Workers’ comp in the U.S. may present a unique opportunity for optimal utilization of chiropractic care because of the system structure. Unlike individuals seeking treatment for non-occupational injuries, workers’ comp patients have a claims examiner, often a nurse case manager and others assisting in the coordination of their care. These professionals are trained in managing complex cases, asking the right questions, and facilitating communication and cooperation between treatment providers. Since occupational injuries are covered under workers’ comp, patients don’t have to worry about copays to multiple specialists and meeting medical plan deductibles. Instead, they and their claims team can focus on pursuing the right care from the right treatment providers at the right time.

I hope that WCRI’s publication opens the door to greater consideration of chiropractic care with physical medicine modalities in workers’ compensation cases and to a reexamination of the regulations currently limiting the access of injured workers in certain states to high-quality, evidence-based chiropractic care.

Empowering injured workers: the role of a surgery nurse

September 7, 2022

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By Tracey Davanport, VP, clinical operations and Melissa Shannon, senior clinical team lead

Getting ready for the workday. Going on a walk with family. Grocery shopping. Working out with a friend. These scenes are what many of us typically associate with a normal routine. But for injured workers, life is quickly turned upside down. Navigating the unknowns and next steps can take an emotional toll, especially for those facing surgery as the best option to returning to what they love to do.

Aside from their concerns about the safety of a procedure or potential pain, injured workers often panic about the financial and psychosocial component of being out of work. Not to mention, worry about how and when they will be able to return to work and their prior level of function. In the midst of uncertainty, they want more than anything to feel heard and to know that someone is there for them. This is where a surgery nurse steps in — to listen; to provide educational resources; to give reassurance; and to be an advocate for the injured worker when they need it most.

Advocacy

When Carly*, a 19-year-old employee suffered a fractured ankle, a claim was opened to a surgery nurse a few weeks ahead of her scheduled surgery. During initial contact, the assigned nurse discovered that Carly lived on the third floor of an apartment without access to an elevator. Not to mention, her space only had a bathtub. Thankfully, the nurse took swift action to inform the provider and request durable medical equipment (DME). Crutches, a rolling scooter, and a device for the tub to keep her foot out and dry were secured prior to surgery. The nurse also scheduled a pre-operation physical therapy visit to make sure Carly felt confident in her ability to use the equipment and recover as soon as possible.

Another injured worker, Sam* was scheduled to undergo outpatient knee surgery when a surgery nurse was flagged. Due to a pre-existing heart condition, Sam was worried about the safety of the procedure. After listening to his concerns, the assigned surgery nurse informed the physician’s office, and the procedure was transitioned to inpatient. To give Sam added peace of mind, they spent time walking through the process and planning next steps. It’s instances like this where the surgery nurse can help fill in the gaps, problem solve and ultimately, advocate for the injured worker when they hit a bump in the road.

Resiliency

To bounce back after a surgery, injured workers can benefit from consistent, regular communication with a surgery nurse. Gary* is just one example. Post shoulder surgery, a technician paid a visit to his home to set up ice therapy. Having left without educating Gary on how to put his sling back on, he felt lost and anxious. Gary was able to connect with his surgery nurse who walked him through the process of getting back into the sling safely. The nurse continued to contact Gary over the course of six weeks to make sure he was attending physical therapy, answer any questions and encourage him to keep going. By building these relationships early on, nurses are seen as trusted advocates and educators to the injured worker throughout the recovery process.

Influencing outcomes and making a difference

An injured worker’s greatest hope is to recover in a way that allows them to return to their everyday routines, to improve their health, to get back to work and to continue doing the things they love to do. Sometimes, this may require the surgery nurse to coordinate care with the physician, examiner, and employer. Other times, they are there to ensure a smooth discharge experience, monitor pain management and document recovery. But no matter the circumstance, they are always there to give injured workers peace of mind.

Our surgery nurse solution helps injured employees facing surgery to be better prepared physically and mentally, and to confidently steer themselves toward a faster recovery. Surgery nurses help achieve the best outcome for every injured worker by working closely with one another and in collaboration with adjusters, doctors, and ancillary care teams. For more information, read our flyer or visit our website.

*Names have been changed in these cases to protect privacy.

Embrace, elevate and expand your view at WCI 2022

August 21, 2022

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Written by David Stills, senior vice president, carrier and risk practice

All eyes on workers’ compensation… and a look at what’s next

Workers’ compensation is comprised of multiple state systems, each with their own unique set of rules and regulations that are in constant flux. The definition of compensability is continually evolving and benefits are constantly changing — as are the needs and expectations of the injured workers and companies. During the Workers’ Compensation Institute’s (WCI) annual Workers’ Compensation Educational Conference, an array of stakeholders representing all facets of the industry will come together to discuss some of the most pressing workers’ compensation issues and what’s next. Throughout our series of sessions, experts will discuss ways to elevate the injured worker’s experience, optimize outcomes and streamline the claims process. Here is a glimpse at what’s coming your way.

Examining medical care advancements for today’s injured worker

Monday, August 21 | 1-2pm

The medical care and recovery environment of an injured worker largely determines the outcome of a workers’ compensation claim. Effectiveness is driven by how quickly care is administered and the appropriateness of the treatment that is provided. Greater emphasis is being placed on providing more holistic treatment of an injured worker. The introduction of behavioral health specialists, pain specialists, and surgery nurses are being more widely adopted and embraced to improve experience and outcomes. Telehealth is making medical follow-up more convenient and increasing adherence to prescribed treatment plans. The importance of medical literacy is becoming better understood and there are increasing communications around treatment options, pre-existing conditions, current medications, and other factors that can impact recovery. When quality medical care is rendered, an injured worker is better able to focus on healing, recovery, and returning to an active and productive lifestyle.

Speakers: Tara Acton, claims director & counsel, Lumen Technologies Dr. Teresa Bartlett, managing director, Senior Medical Officer, Sedgwick Michele Maffei, director of workers’ compensation, Publix Super Markets

Looking at ways to streamline the claims process to optimize outcomes and experience

Monday, August 21 | 2:15-3:15pm

A claims strategy with a strong employee focus is paramount in today’s competitive business environment. Impressions are formed at the time an incident is reported and continue throughout the recovery and return to work process. Individuals will note the urgency, compassion, and concern expressed in response to their injury, the communication and guidance they are provided throughout the claims process, and the degree to which a fair and equitable settlement is established. Employers must ensure their culture and brand are manifested in all aspects of the workers’ compensation process, particularly in their interactions with employees. This session will focus on practical and proven strategies to elevate employee experience, corporate brand, and financial performance.

Speakers: Patti Colwell, workers’ compensation program manager, Southwest Airlines Max Koonce, chief claims officer, Sedgwick Nancy Strubler, director of workers’ compensation, National Express, LLC

Focusing on data patterns, emerging trends and specialty research to mirror future impact

Monday, August 21 | 3:15-4:15pm

Well-known industry specialists will share highlights from their in-depth analyses and research related to areas having a notable impact on workers’ compensation. Hear one of the industry’s leading researchers share new insights around provider consolidation and its projected impact on injured worker care and costs. Listen to a highly acclaimed chief data officer as he shares patterns detected in data and what these can indicate about future litigation using attorney firm scorecards. And take note of trends emerging from California research that relate to access to care and what they may mean for workers and businesses across the rest of the country. Data patterns, emerging trends, and specialty research of this magnitude are as close as it gets to mirroring future happenings.

Speakers: Adam Fisher, chief data officer, Sedgwick John Ruser, president and CEO, The Workers’ Compensation Research Institute Alex Swedlow, president, California Workers’ Compensation Institute

The opportunities at this year’s WCI conference will be one more reminder that our professional lives have meaning and impact. When we work together under unique circumstances, the industry is stronger and the injured worker experience is improved.

We’ll see you at the conference, but in the meantime…

  • Catch up on the latest edge magazine articles.
  • Follow Sedgwick on LinkedInTwitter and Instagram for live updates.
  • Search #WCI2022 to explore what’s trending on social media the week of the show.

Every step of the way, we’re here to help you embrace, elevate and expand your view. Find us at booth #803 to connect with leaders throughout the conference.

Paving the way for improved recovery and return to work outcomes

August 11, 2022

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By Shane O’Dea, head of strategic partnerships and programs, workers compensation

When an employee is unable to work due to an illness or injury, early communication is key to improving recovery and return to work outcomes. In fact, research in Australia suggests that when contact is made with an injured worker within the first three days post-injury, their return to work outcomes increase substantially by up to 63% for psychological injuries and up to 26% for physical injuries.

Back to work sooner and healthier

WorkSafe Victoria, the second largest Australian jurisdiction, is currently running a major campaign to reinforce this message. The campaign includes access to a toolkit providing guidance on how to start and maintain conversations with ill or injured employees. Additionally, Australian regulators have tailored their websites with similar guidance – providing employers with simple and adaptable tasks to support a positive recovery and return to work experience.

recent report states that when an injury notification and claims lodgment is raised quickly, the overall recovery and return to work process is more efficient. Whereas in cases that involve a delay, the employee is more likely to need an extended period away from work. In circumstances where an injured or ill employee received early support from their employer and colleagues, the employee demonstrated lower levels of concern in raising a claim. Furthermore, employees who are not concerned about making a claim are more than three times likely to return to work.

A shared purpose

What’s encouraging for both employees and employers is that there are countless resources available for ill or injured workers. As technology improves, digital platforms can promote a higher degree of connectivity and engagement. MySedgwick and smart.ly are two examples. To assist businesses in simplifying the recovery and return to work process, our self-service portal, MySedgwick provides clients and injured workers access to claims status, payment history, claim documents and more — by tablet, computer or smartphone. Smart.ly integrates forward-thinking technology behind the scenes so that the intake process is simple to the end user.

People-first approach

As Australia continues to experience skilled labour shortages across many sectors, we have a renewed focus on keeping the workforce healthy, well and productive. This includes supporting those who experience an injury or illness in their recovery and return to work. When a people-first approach in absence management and workers compensation is properly implemented, employers are able to improve employee health, recovery and return to work outcomes for a relatively low investment. Sedgwick’s Direct Health Solutions (DHS) 24/7 nurse triage service offers real-time injury or absence notifications to enable early contact opportunities. A service that will be part of the Sedgwick claims model in Australia.

In Sedgwick’s Direct Health Solutions (DHS) 2019 survey capturing responses from 104 organizations across Australia, respondents were asked to provide data based on all unplanned absenteeism, including personal leave, workers compensation leave and unauthorised leave (paid and unpaid). The results show absenteeism increased by 1.5 days — to 11.2 days per employee per annum compared to 2017. Absenteeism is estimated to cost the Australian economy over $35 billion in wages and lost productivity. Also worth noting, 85% of respondents indicated they were focused on managing absenteeism in their organisation, an increase of 12% from our 2017 survey.

While there are always evolving challenges related to return to work, creative thinking and the use of the latest technology can help us find solutions and exceed expectations. Whether an employee needs to take time off work for an illness or other life event, or a person is injured on-the-job, on a client’s premises or by their equipment or products, the Sedgwick team in Australia and around the world is here to take care of each of them. To learn more about improving return to work outcomes, contact [email protected].

Embracing new dimensions of return to work

July 14, 2022

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By Shane O’Dea, head of strategic partnerships and programs, workers compensation

Grabbing breakfast on-the-go, rushing to catch public transportation, or getting stuck in bumper-to-bumper traffic in order to work the traditional 9-to-5 is no longer the standard for many in the workforce in Australia and around the world.

Remote, hybrid and flexible work options continue to present employers with opportunities to help employees stay healthy and safe and support them if they experience an illness or injury.

Well-being

The Australasian Faculty of Occupational and Environmental Medicine (AFOEM), a faculty of the Royal Australasian College of Physicians (RACP), introduced a consensus statement over a decade ago with compelling evidence about the positive impact work can have on employee health and well-being. This still rings true today, but as the needs of employees continue to evolve, “work” has been redefined — and so has the idea of well-being. It’s no secret that many prefer the flexible work arrangements that became the norm during the pandemic. Many employers have reaped the benefits themselves — from improved resilience among their workforce to more positive outcomes for injured or ill employees during their recovery and return. The message is clear: addressing well-being at work is advantageous for everyone involved.

Adaptability

As a resident of Melbourne, Australia — one of the most restricted cities in the world at the peak of the pandemic — I witnessed firsthand the adaptability of injured workers and those supporting them, despite the difficult circumstances. Many relied on employee assistance programs (EAPs) and other early intervention methods for support, and employers rose to the challenge of finding new ways to address their needs. In the United States, telehealth options proved to be an effective approach to treatment. Others who felt well enough were able to work remotely while experiencing a mild case of the flu or even COVID-19. They could not be on-site at work because of the risk to their colleagues and various government mandates, but flexible work options and a dose of resilience enabled them to remain productive while recovering at home.

Following Sedgwick’s acquisition of Direct Health Solutions (DHS), we saw firsthand the positive impact 24/7 nurse triage access had on employers supporting their ill or injured employees. In any given month since March 2020, up to 50% of DHS’ client workforces would contact them for employee absenteeism or injury assistance. In addition to on-call clinical support, DHS offered a human resource service to supplement employee assistance programs (EAPs). This allowed employers to support employee psychological connection at the workplace and overall well-being.

Employer considerations

Employers have an obligation to create and maintain a safe work environment — whether workers are on-site, remote or follow a hybrid schedule. Doing so requires a thoughtful plan for injury prevention, recovery and return to work. This may mean implementing mental and physical assessments of the workplace, redefining structure and connectivity or the willingness to make adjustments and provide accommodations. Complying with government guidelines and regulations is another factor to consider as employers update their policies. Following an advocacy model can help ensure the best level of support and care that leads to the best possible outcome.

What’s next?

While there are always evolving challenges related to return to work, creative thinking and the use of the latest technology can help us find solutions and exceed expectations. Whether an employee needs to take time off work for an illness or other life event, or a person is injured on-the-job, on a client’s premises or by their equipment or products, the Sedgwick team in Australia and around the world is here to take care of each of them. To learn more, visit our website.

Making a difference: a celebration of nurses

May 6, 2022

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By Beth Burry-Jackson, SVP, managed care operations

An interview with Beth Burry, SVP, managed care operations

In celebration of May being Nurses Month, we (virtually) sat down with Beth Burry to learn more about the important roles nurses play at Sedgwick.

Tell us about your position.

As senior vice president of managed care, I oversee a team of more than 650 talented colleagues — most of whom are nurses. These skilled professionals specialize in telephonic and field case management, crisis caresurgery prehabilitation and rehabilitation, behavioral health, return-to-work management and transitional work placement. Our clinical teams provide care and support for our clients’ employees when they incur a work-related injury or illness.

The theme of Nurses Month 2022 is “nurses make a difference.” How do nurses make a difference at Sedgwick?

While our nurses may not physically deliver care in the “traditional” sense that people picture in a doctor’s office or hospital setting, they are true representatives of Sedgwick’s caring counts philosophy. Taking care of injured and ill workers is at the heart of everything they do. They tirelessly advocate for our clients’ employees, identifying supportive solutions to remove any barriers that stand between employees and their health, wellness and productivity goals. Our nurses take an individualized approach to ensure that everyone whose care is entrusted to us has what they need to pursue maximum recovery and get back to their lives — or adapt to a new and altered reality.

Sedgwick nurses engage in the claims process in ways no one else can. The important work performed by our examiners and other claims stakeholders is done at a distance — behind a computer screen or via phone/text. Our field nurses, on the other hand, are the only Sedgwick colleagues who have face-to-face interaction with injured workers, accompanying them to medical appointments or visiting their homes to demonstrate safe ways to perform activities of daily living.

We have the unique opportunity to provide supportive interventions in individuals’ lives when something unexpected and adverse happens at work. We help people navigate a complex health care system with which they may be unfamiliar. And, we stay involved as long as needed to facilitate ongoing recovery. Nurses in doctors’ offices and hospitals don’t often get to see what happens to their patients, but our nurses do. That’s how we make a meaningful difference in tens of thousands of lives each year.

Can you share some memorable cases in which Sedgwick nurses made a difference?

Here are a couple of recent ones that stand out in my mind:

  • A client employee tragically lost both his legs in a work-related accident. One of our nurses worked closely with him and his wife for months, helping them obtain custom prosthetics and a wheelchair and specialized bed for their home. She also checked in daily when issues arose with his wound care. The accident changed his life forever, but our nurse provided the critical support needed to help him resume living.
  •  A Sedgwick nurse made a check-in call to a client employee with COVID symptoms. She could tell over the phone that the employee was short of breath and struggling to communicate. When the call was disconnected and our nurse couldn’t reach the employee, she immediately called 911 and sent emergency personnel to her home. The employee was in distress; thankfully, she received the necessary treatment and had a good outcome. Our nurse’s tenacity and quick thinking saved the employee’s life!

Our nurses make a life-altering difference in the lives of our clients’ employees every day!

What health care trends are you and your team seeing in employee health and wellness?

It comes as no surprise that employers are paying more attention to mental health. They’re realizing that a healthy work environment free of undue stress contributes to overall employee satisfaction. Happy employees are not only less likely to leave; they’re also less likely to get injured, and they tend to recover faster and return to work sooner if they do suffer an on-the-job accident. The new mindset is that a happy employee is a healthier employee. Clients are increasingly taking advantage of our behavioral health specialists as part of a smooth return-to-work process.

Another noteworthy trend is adopting a holistic view of health. This is an area in which our nurses are particularly effective. For example, clients who use our surgery nurse services have a specialized nurse assigned to the case of any employee undergoing a non-emergency surgery. In one case, during the prehabilitation process, our nurse found that the employee was incredibly anxious about her upcoming knee surgery. The nurse soon learned that the employee had suffered a heart attack a few years earlier; that is certainly a comorbidity that can impact recovery! Our nurse arranged for the employee to undergo a rigorous preoperative evaluation and insisted the procedure be performed at a hospital, rather than an outpatient surgery center, to ensure preparedness for any cardiac issues. Not all knee surgeries are created equal; we need to consider each individual patient’s health holistically, so they receive the very best care for them.

What’s your best advice for healthy and productive living?

First, I would say to focus on self-care routines. By that, I don’t mean taking a bubble bath by candlelight; I mean finding things every day that take care of your body and mind. So many of us are sedentary in our jobs and have been staying home more than ever because of COVID, so we need to get moving! It’s critical to have some kind of physical movement routine, whether it’s walking, running, yoga or something else that you enjoy.

The other piece that balances that out is taking care of others. I am lucky enough to supervise a group of colleagues who got into their professions because they care about people and want to give to others. Making a difference in somebody else’s life can bring a lot of meaning to yours. That’s what our nurses do every day.

Special thanks to Sedgwick RNs Jennifer Beale, Barb Gardner, Stacy Hastings, Jill King and Judiann McCrone Romeo for their valuable contributions to this blog.

If you’re interested in career opportunities as a nurse at Sedgwick, please visit our website.

Navigating the workers’ compensation landscape in Canada

April 6, 2022

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By Dan Ogale, AVP, workers’ compensation, Canada

Sedgwick is best known in Canada for property loss adjusting and related services, but did you know that we’re also one of the leading Canadian third party administrators (TPAs) in the workers’ compensation (WC) arena?

Many of the inquiries we get about workers’ compensation in Canada come from U.S.-based employers who have employees north of the border and are largely unfamiliar with the workings of the Canadian system. This blog aims to educate readers on the workers’ compensation landscape in Canada and outline the benefits of having a Canadian TPA partner.

Comparing the American and Canadian workers’ compensation systems

Just as WC is legislated at the state (vs. federal) level in the United States, it’s mandated at the equivalent province/territory level in Canada. However, unlike the privatization found in most U.S. states, the Canadian workers’ compensation system operates similarly to those with monopolistic, government-owned state funds, such as Ohio and Washington.

Canadian employers obtain workers’ compensation coverage by paying premiums to the Workers’ Compensation Boards (WCBs) in the provinces/territories where they have employees. These boards are jurisdictionally regulated throughout the country, and each has its own set of rules about the workers’ compensation claims process. The boards determine the workers’ compensation rates charged to employers based on their payroll records. Canadian employers cannot purchase WC coverage from an insurer or self-insure their WC programs.

One key difference in workers’ compensation between Canada and the U.S. is the primary driver of cost. Whereas the medical costs associated with treating injured and ill workers are the leading source of workers’ compensation expense in the U.S., lost time benefits paid to workers drive most of the costs in Canada. Although there is a universal healthcare system in Canada, the costs associated with medical care for workplace injuries and illnesses are included in employers’ cost statements.

Another distinction is that Canada does not have the same kind of jurisdiction-specific licensing requirements as the U.S. for those handling workers’ compensation claims. In Canada, these professionals are often referred to as “consultants,” as opposed to “examiners” or “adjusters,” and play more of an advisory role than their U.S. counterparts.

What a Canadian TPA can do for you

In many organizations, payment of workers’ compensation premiums is a function of the human resources or accounting department. This often results in poor internal oversight of claims. An experienced TPA can help employers navigate their workers’ compensation claims that are being administered by the provincial WCBs. In Canada, TPAs act as liaisons between employers and the provincial WCBs. They work to ensure that employers’ interests are being addressed. Effective TPAs help their clients proactively reduce workers’ compensation claims costs, using tactics such as identifying barriers to early claim resolution; exploring opportunities for loss transfer; reviewing medical information; managing hearings, arbitrations and appeals; and promoting timely return to work — especially on claims most likely to impact premiums. They also work to ensure that clients’ employees are well cared for following a work-related illness or injury and receive the support needed to achieve maximum recovery and return to productivity.

For organizations with employees in multiple provinces/territories, it’s can be helpful to have a national TPA partner that’s knowledgeable in the various legislative structures and has good working relationships with each of the WCBs. Multinational organizations with a presence in Canada can further benefit from partnering with a TPA that has global claims and reporting systems for ease of use and the ability to produce apples-to-apples analyses of key performance indictors (KPIs) across various geographies; this enables risk management professionals to more effectively implement health and safety measures that can drive down WC costs.

Here are a few examples that demonstrate the value Sedgwick delivers for our Canadian clients:

  • As part of a takeover of open claims, we began managing one that began two years ago, when a client’s employee was struck by a vehicle owned by another employer. The employee sustained significant injuries, and the claim was quickly approaching our client’s maximum cap of approximately $425,000. Our client was not previously aware of the opportunity for cost relief on this claim. We were able to get all of the claim costs transferred to the vehicle owner, and $425,000 was credited back to our client! Our team’s experience and knowledge of the provincial legislation yielded significant savings for our client in this case.
  • A client’s employee complained of chest and shoulder pain at work. After a careful review of the claim, we determined that the incident was non-occupational in nature and therefore requested a denial; however, the WCB allowed the claim to proceed. We objected on behalf of our client and received little response from the WCB. Our team persisted in following up and months later got the WCB to acknowledge that the claim should never have gone through the workers’ compensation system. The client was able to remove this incident from their annual experience rating, which lowered their premium costs for the following year.
  • A client’s employee suffered a back injury at work and was off the job for nearly four months. Our WC specialists discovered that the employee had a pre-existing condition and requested cost relief for the final two months due to the waiting period. It took nearly 10 months of working with the WCB, but we secured a significant recovery of wages. When compared to the client’s annual service fees paid, their return on investment (ROI) from partnering with us on this claim was more than 200%!

Given the complexities of the Canadian landscape, an experienced TPA is a critical partner to have in navigating the workers’ compensation system, controlling costs, and taking good care of employees. If you’d like to learn more about what Sedgwick can do for your Canadian workers’ compensation program, please don’t hesitate to contact me at [email protected].