Beyond the Claim
Beyond the Claim

Episode 2 · 1 month ago

Workers’ Compensation in the Pandemic & Beyond w/ Theresa Clarke


Where would you expect to find a loss prevention officer bitten by a snake hidden in a shoplifter’s purse?

Filing for workers’ compensation, of course.

If you thought insurance was boring, then there are millions of similar stories that beg to differ.

But when they’re not dealing with claims snatched from a Guy Ritchie script, the professionals in Workers’ Compensation are doing vital work to ensure employees get back to their feet and back to work.

Just ask today’s guest, Theresa Clarke, Manager of Workers’ Compensation at Advocate Aurora Health, where she and her team have risen to the challenges of the pandemic to help frontline workers get what they need to get back in the fight against COVID-19.

In this episode, we discuss:

  • Why workers’ compensation is a fun and rewarding career
  • The role workers’ compensation has played in the pandemic response
  • How Workers’ Compensation is incorporating a proactive, preventative approach to future claims

Need more claims strategy in your life? Check us out on Apple Podcasts, Spotify, or on our website.

Listening on a desktop & can’t see the links? Just search for Beyond the Claim on your favorite podcast player.

The best claim is one that never getsfiled the best one is when nobody gets injured in the first place. The secondbest claim is getting it paid and appropriate medical treatment andhaving that person get back to their pre injury status and their heelsyou're. Listening to beyond the claim, the show for forward thinking risk andclaims professionals curious about the latest industry, Trans winningstrategies and stories from influential leaders, let's dive in hello, andwelcome to this episode of beyond the claim, with your host Mark Cunninghamchief sales, a marketing officer with broad spire. Today, I have with meTeresa Clark Teresa a manager workers compensation at Advocate Health Aurorato reach the welcome think so much for having me. I appreciate it. Thank you.Thank you for sharing your time with us, looking forward to the conversations sofor folks that don't know Teresa what does advocate or our health do and whatdo you do it at African Ro ser advocate rer health is a group of hospitals andmedical facilities throughout Wisconsin and Illinois. We support about seventyseven thousand employees throughout the the two different jurisdiction. So mymain role is management and mitigation of or comp claimed throughout theorganization. So I I'm curious. I asked folks you know for their kind of theirback story as they we get into our conversation and in looking throughyour profile and BIOS. I saw a path that I think I see sometimes, but Idon't know that many really leverage to take advantage of- and it's just, Ithink, it's impressive- to see the journey that folks have within the riskspace. I think your your first job with in a rest pace was in the justercapacity of that right, correct yeah, I graduated from W White Water and two thousand andthree I think, and my first job out of college was at a Wisconsin insurancecarrier kind of adjusting claimed throughout several differentjurisdictions, and then, after that time, in the adjuster realm, I got myproperty and casualty. Health life and accident producer license and kind ofsold some TP services. So I went over to to the agency side, following that.I worked on the employer side for a national retail clothing company kindof managing their Workers Cup Program and its at times twenty six differentjurisdictions, and my most recent previous role was the director of workcamp at a self injured group Cap Captive in Illinois and Indiana. Sothis manager, roll at advocator, is kind of a perfect Sarandiy. You knowresolution for eighteen years of experience, adjusting and on the agencyside and with TPA that's fantastic, fantastic. I know we were going throughor aproaching our silver sunam apparently, and I think, there's athere's a need for many to understand that there is a pathway, a journey formany of us within this risk space and they can take on different forms andtheir different facets to it. So I love hearing that story it does before. Iask you more about what you're doing. Today, though, I do have the ASS,because part of the reason that we're...

...kind of been a void of talent to aagree were re approaching that right, if we don't manage to ride away, isbecause many don't see that journey from when I was in elementary school toyou know, go into rispondi right, it's not one of those hey. I want to be arisk manager instead of you, know, quarterback or a scientist. So so howdid it so? So? What did you anticipate yourself doing and then how did you go?You know, as you left school into the risbands space, sure a great question.I don't think any little kid. You know wakes up thinking, they're going to bean insurance suggestor, that's going to be what their career path is, but it'soften not presented even in college is kind of an opportunity. So I took a youknow a little bit different route. We started in the claims, Department orstarted in the claims department, and you know in college- that's notpresented as an opportunity. Most of the opportunities you hear about ininsurance are either on the underwriting side or things like thator sales. But claims is then it's a very study. It's a consistent job. It'salways going to be there. You can make good money if you're, if you are doingyour job correctly and you like the work. When I was a kid, I thought I wasgoing to be a lawyer, so this kind of pairs very closely. I like theinvestigation I like really digging in and getting my hands dirty and learningabout each claim is so different, so of being able to learn the intricacies ofwhat and why and how to help. That's really what I've had a love affair with.I love it very nice yeah. I think, for those that can- and I see this spendsof time in the benefits pace as well. If you're can appreciate the journey,not necessarily being mapped out ahead of time, I think you can really,especially if you have a personality that thrives in that space. I think youcan really. You know accomplish some things that you know that maybe nothave anticipated or even aspired to no otherwise, so that's great so avocatRur health system. You know I was going to say that we're a tail in the middle-I don't know where we are with the pandemics I'll put that out there, butI do know this been going on for at least twenty months now. What's beenthe impact to you know your organization to your employees. What'sbeen the in fact from a work is conversation standpoint. How is this o?How things fare it from the health system perspective terror? How long dowe have it? It's been. It's been massive. It really has not only fromover com standpoint, but you know supporting those frontline workers isso imperative, because, if they're not healthy and being able to take care ofthe sick patients, we have nothing left. So our support, I think, on the workcomp end and the team member health and safety and is invaluable. We reallyneed to understand that that our supporting role is only helping thefrontline workers who are doing that really hard job at Dan and day out. Ourclaims volume has probably tripled in the past twenty months or so, and myincredible team has been able to stay within their space. We haven't had anyincrease in our in our number of...

...employees. We've been able to keep thesame number of employees within the departments and they've just handled itthey're incredibly resilient. My team is his fantastic, so I've gotten verylucky that there's a group of very responsible, productive individualsthat work in workers come for me and that's kind of helped us build and beable to keep our heads of of water, because this has been a really reallytough hear. Yeah. That's amazing! That's that about just keeping thatcourt team in the core group in place throughout this. THAT'S NOT COMMON!These days, it's a coud host O us a couple ofothers, but it happens, though I could have been that achievement that die.Have you from a you know an organized perspective? Have you, as I been anystruggle with classifying the classification of theseovid related claims to specifically to your employees, and maybe even some ofthe you know, the long term, symptoms or Cole Morbidity that have occurred atwhich approach of you will taking? If you takin a hey, you know this issomewhat fluid. You know we're going to assume. There is a relation ofcorrelation and before, as a COT, plane war has it been more of it's? Not allwe unless it's clearly defined. You know it's work later or not regulated.What do you see yourself going in? I need to go a direction yes, yesadvocate is it has taken a very measured approach into which claims arebeing accepted and which are not being a health care provider. I think the thelegislature in both Wisconsin and Illinois have kind of given USguidelines about frontline workers in Wisconsin. If you can trace it back toone patient or one co worker that had cobi that you can point to that personand say that's likely where I got it. That's an accepted work comp claim inIllinois if you're working with a group of people that you think that was theexposure it's likely going to be accepted. So due to the legislature andhaving kind of the presumption of contagion, it's made the accepting anddetermining the cause of these coved exposures a little bit easier than Iwould say that the general public so follow question. To that I mean I knowyou know, there's another variant out. We don't have a solid with confidence,can't say what tomorrow the next month holds, but at least for what you you'replanning for. Where do you see? How do you see that your organization, youindividually continuing to plan for prepared for potentially react to thisthis this current norm this new norm? Absolutely, I think that the vaccine isreally and we've mandated the vaccine. Our deadline is coming up October,fifteenth so every one of our employees, whether you stay at home, whetheryou're, a frontline employee or office employee, will have to get a covedvaccine, and I think that is going to take big steps into reducing the numberof coved exposures. The delta variant... really has been devastating. It'sthose are the the sickest that I've seen. These claims come through thesickest people, the youngest people. So it's it truly is devastating to see howit's impacting our team members and how it's impacting their lives. Theirfamily is their spouses. So I think the vaccine really is going to move us intoa direction that word we're going to be able to manage and and mitigate those.The numbers have gone down. So thankfully we're not seeing as manycatastrophic injuries the hypoxic brain injuries or the hair Plica. Due tothese strokes and things like that happened very early on in the pandemicand while they're still getting some of them are still coming through. Thenumbers have drops: That's good, that's a positive silver lining for sure it'sgood to hear Ye. So, let's speaking a positive out pivot, a bit MC, you know,so I have to imagine that you've had some wins as well over the course ofyou know the past year or so anything that stands out to you. That says youknow we did that we did that well, proud of that or that you're preparingfor and you see the the you know the horizon and it looks good anything youcall out. Yes, absolutely my team has had so many it's. We have a lot of typeor we have sometimes so hopefully I can go through some of them, but we've beenable to do so much really during this exceptionally difficult time and theresilience dedication of my team has really driven that success. You knowwe're in the middle of a global pandemic affecting the frontlineworkers, so we are were bombed all the time and we're also harmonizing twoprograms, the advocate of Illinois side and the Wisconsin Auroras side whenthey merged. I want to say it was in two thousand and sixteen, but don'thold me to that. The two programs had to decide. You know here's ourphilosophy over here: here's our philosophy: How are they going to mash?So that's been an ongoing issue for a couple O years. It's taken a lot of alot of really hard work. Also in the middle of this we change brokers andcarriers and I'm the project manager for building out a new risk managementinsurance platform. So we are doing everything all at once and my wonderfulteam has been really patient with me. Changes sometimes pretty difficult,it's scary, when a lot of the areas of that job arechanging kind of all. At the same time, you can create someone's certainty, butluckily our team has faith kind of in the big picture and trust in ourmanagement and leadership on why the changes need to occur. So ourdepartment really has been fostering close relationships with team memberhealth and safety was legal with our employ health and knockholt teams, sowith so many balls in the air and just really really proud of my team forbeing able to manage excel at not only their roles but also coordinating withother departments and being open to change. So my mate has always been thatour department is kind of responsible for taking care of the sick or injuredteam members, so they can get back to...

...caring for our patients and the teamhas really taken that and run with it. So what I'm hearing is managing to thepandemic alone? Wasn't enough o Takin a and he soon that was not on turn overturn that you did that, okay, O could see you, that's impressive!That's and it's, I think you know. Kidding aside, I mean doing that, given the change in environment thatthat I'm sure you all have gone through as well with I'm sure many people meanyou have more frontino or so maybe remote is not as sick as free hasn'tbeen as consistent for you over the past twenty months, but regardlessmanaging through that environment and then also taking on what sounds likemore new projects as well as closing out some that were already in flight.That's that's pretty significant in this current state of affairs, where wefind ourselves on more so than ever before the natural breaks of old,whether it be commutes or travel or what have you. Those are are gone thatyour constant meetings constant got time. T that's a lot to take on in thatperiod of time. That's that's impressive! Congratulations! Thank you!So if you are looking at the industry at a maybe more macere level- and yousay you know- I have eighteen years experience- I've seen and done a littleeverything you know we're taking on new challenges now. Have there been thingsalong the way that you said you know this? Is I don't think individualsoutside of the space really get it? You know, there's some misunderstandings ormisconceptions about either what we do, how we get it done or how we canimprove it. Anything like that! Stick out to you, yeah, absolutely there's!You know some misconception about the insurance industry and just insuranceisn't always boring. Insurance involves so many different facets andpartnerships with lawyers, doctors, judges in a place term, really allwalks of life. So every claim is different. One day you may be handlinga case of a traveling employee who is involved in like an auto accident, andthen the next claim could be a retail lost, pose vension officer who was bitby a snake. I was hiding in a shoplifter's purse, so you never knowwhat the day is going to give you and those quite like. If you talk withinsurance professionals, they have some incredible stories. Every single personthat I've met in the industry has a crazy story like that. So it's reallyinteresting. If you ever seen the movie the incredibles, I have a five year old.So, Mr Incredible his day, jobbers cover job was an insurance handler andI think the preconception of insurance work is kind of a boring. STAGY. Blandjob isn't really accurate these days yeah. I totally agree with it. So now Idid the snakes question. The stake story. Excuse me, was that intentional,or is that just by chance? Well, I think we decided that they, theshoplifter, had the snake in the purse and then, when the last preventionperson wants to go, find the item that they thought they had shoplifted boom,there's a snake there and D it may have...

...been a just. I don't know you to the claim that an not I can tellyou, but I just came from the exotic pet store right and probably Choclat. Did that great point you be right, though, the stories thatare out there and even the I'd say the the pathway to the injury I mean, whichis part of the story. It's just it's incredible. You know what and then,then you hear what in some individuals go through and that are Adam abouttheir recovery. To you know you hear those those recovery stories that arejust when you have people that go through reputations and permanentdisabilities of sorts of partial, at least and they're able to recover to apoint where they are productive. You know citizens and some typing somecases more than they were before it's in power. O to your point on you knowit's often the industry is often seen in a certain light. I think that thereis just there's so much reward that can come out of it various roles inpositions so yeah. I agree that if there's, if anyone is interested inherland learning more, they really should or or see that as a potentialpathway. They really should. You know, investigate further, because there's alot to be gained from it for sure. So is there anything out there that yousee as hey? I need to fix this like we need to fix this. You know this. Is it's been this way orit's at risk of going this way, and- and this is something that I would loveto get my hands around it and really change. If I could M God, I wish list,I certainly have plenty, I think I'll go with one technical thing that wehave been struggling with. I think on a technical legal end of things that Ibelieve there should be a cap on a person of a person as a whole benefitat a hundred percent total, not per injury. So these frequent fliers,people who have multiple claims, can actually stack these permanentdisability ratings and end up earning more than a hundred percent of theirentire body. For a disability, it doesn't make make much sense on a youknow, logical sense, so it also incentivize them to kind of continuefiling claims. So I will keep it at that. No so we're some or audience isbrand new to the space. So what you just described- something they've,never heard before so expanding that a little bit for me, so that you'resaying that they could have, they could take advantage of a point within aclaim that would exceed financially the return of where they were pre.Disability sure so a permanent disability is is rated based on thebody part that was injured, and this is both in Wisconsin and Illinois. Man asa whole or person as a whole disability is usually captat about five hundredweeks, and that's just the benefits that you would be paid out if you werecompletely disap disabled due to the work injury. So each body part itsounds a little weird, but each body part including, like you know littlefinger down to your toes- has a rating with the state and this that's allstate mandated. If you have a...

...disability that gives you a certainpercentage, the doctor, at the end of your healing, will say you have thisback surgery. I think you have twenty percent permanent disability. Due tothis injury. Here's, your writing and the Insurance Company pays out acertain amount of money based on your wages. You can stack that to more thana hundred percent which to me that doesn't make sense if, if a body as awhole is rated at five hundred weeks, you shouldn't be able to get six orseven hundred weeks of disability for several concurrent back injuries, butit's an opportunity, I think for improvement, but the the state doesn'talways get it right. Neither state gets it right. Nobody gets there right allthe time. So this is an opportunity I think, for being able to cap it and puta little bit more pressure on the frequent flyers or the people who are.Are. You know career workers, comp filers, we do know those exists outthere. Unfortunately, there are many people that are appropriately filingclaims, have legitimate situations and injuries, and then I think, just as inlife in general, have in Vivas going to take advantage of the system. So that'sthat's good to know. It's definitely good to know. So, as we as we lookforward as you look forward, you know, months year or years down the road isthere anything that you see that we don't have today? That would help youdo your job better or that would improve the process for your employeesas they're, going through a claim or you just had a magic one, and you saidHey. If we could do this, you know if we could bring this from my my personalenvironment to this claim environment. It would transform the industry oranything like that out there that comes to mind yeah. You know our our companyhas been fantastic about kind of looking towards the future and whatwhat we can do to keep our employees Tayf and prevent injuries. We arecurrently building out a team member health and safety roles, and responsibility is kind of awhole new department that is going to be more of the proactive let'sprevent.These injuries before they happen were comp, is kind of a reactive and injuryoccurs, and then then we step in so the team, ember health and safety programis designed to kind o. Look at those rout cause analysis figure out why thathappened, figure out if there's a hazard that is evident in more than onelocation and let's go in and fix it. So the best claim is one that never getsfiled the best one is when nobody gets injured in the first place. The secondbest claim is getting it paid and appropriate medical treatment andhaving that person get back to their pre injury status and they're healed.That's the the very best solution. I think there used to be. You know an oldurban legend that the claims adjusters would get a kickback or something forevery denial that they could crank out. And that's not true. So it's you knowit's. It's super important to realize that, ultimately, the company wants thebest for you. You know in ninety nine percent of the cases, so we really arelooking towards the future and trying... prevent those injuries that can becatastrophic. We don't want them to happen in the first place, so it's veryexciting. Our director of team member health and safety and workers,compensation and our manager have been fantastic and we're really excited tobuild that program out excellent. I think we see more organizations from myperspective looking at ways that they can build out. You know advocacy orpreventative programs that may not exist to day to really get ahead of,that was typically ben, a reactive environment. So that's that's great tohear acce well. Thank you. Thank you to been a fantastic conversation teresa,i'm sure they're going to be folks out there. That may want to get a hold ofyou and either ask your question or invite you to a speaking engagement. Infact, i know you have a speaking engagement coming up around theevolving workforce. What's going to be the for we close. What's going to bethe theme of that conversation, we have a couple different things that we'regoing through and working on a panel with a couple of other talented, ladies,that they're really looking at how the work force has changed the work fromhome versus in the office. The hybrid people also looking into what whatcoved has done for our industry as a whole. What are we looking at at claimtrends? What are we looking at a coved, long callers? What type of adaaccommodations would we need to consider for them if there arepermanent disabilities that don't go away? So these are all things thatwe're going to discuss that the wisconsin work cump form, i believe,i'm speaking on the sixth so next wednesday, and we're really excited tokind of have that opportunity to have that that discussion with a group ofgreat professionals- excellent, yes, so and if folks want to reach out to you.Otherwise, what's the bet best way to do that, linkedin is great. You canfind me under teresa clerks or you can send me an email, i'm always availableteresa, theresa at clark clark at a at eight stator with we. So thank you somuch for your time. Love the conversation in love, hearing yourjourney and where you're going next within that story. So thank you andgood luck with everything. Thanks to much markets been a pleasure. You've been listening to beyond theclaim, a podcast for risk and claims leaders to ensure you never miss anepisode. Please subscribe to the show in your favorite podcast player. If youuse apple podcast, we love for you to give us a quick rating for the showjust tap the number of stars that you think the podcast deserves until nexttime stay curious and keep innovating t.

In-Stream Audio Search


Search across all episodes within this podcast

Episodes (5)