Beyond the Claim
Beyond the Claim

Episode 2 · 2 months ago

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

ABOUT THIS EPISODE

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 nevergets filed. The best one is when nobody gets injured in the first place. The second best claim is getting it paid and appropriate medical treatment and havingthat person get back to their pre injury status and their healed. You're listeningto beyond the claim, the show for forward thinking risk and claims professionals curiousabout the latest industry trends, winning strategies and stories from influential leaders. Let'sdive in. Hello and welcome to this episode of beyond the claim with yourhost Mark Cunningham, chief sales and marketing officer with broad spire. Today Ihave with me Teresa Clark. Teresa is a manage of workers compensation at AdvocateHealth Aurora. Teresa, welcome, thanks so much for having me. Iappreciate it. Thank you. Thank you for sharing your time with us.Looking forward to the conversations. So, for folks that don't Know Teresa,what does advocate of our health do and what do you do at advocate rowsure? Advocate of Urura health is a group of hospitals and medical facilities throughoutWisconsin and Illinois. We support about seventy seven thousand employees throughout the the twodifferent jurisdiction. So my main role is management and mitigation of work comp claimsthroughout the organization. So I am curious. I asked folks, you know,for their kind of their backstory as they we get into our conversation andand and looking through your profile and Bios, I saw a path that I thinkI see some sons but I don't know that many really leverage to takeadvantage of and it's just I think it's impressive to see the journey that folkshave within the risk space. I think you're your first job within a riskspace was in the adjuster capacity. That right correct. Yeah, I graduatedfrom uw Whitewater and two thousand and three I think, and my first jobout of college was at a Wisconsin insurance carrier kind of adjusting claims throughout severaldifferent jurisdictions and then after that time in the adjuster realm, I got myproperty and casualty, health, life and accident producer license and kind of soldsome TP services. So I went over to the agency side. Following thatI worked on the employer side for a national retail clothing company kind of managingtheir workers count program and it's at times twenty six different jurisdictions and my mostrecent previous role was the director of work comp at a self insured group,cap captive in Illinois and Indiana. So this manager role at advocate Aurora iskind of a perfect serendipitous, you know, resolution for eighteen years of experience adjustingand on the agency side and with tpas. That's fantastic, fantastic.I know we were going through or approaching our silver tsunami, apparently, andI think there's a there's a need for many to understand that there is apathway, a journey from many of us to within this risk space and itcan take on different forms and their different facets to it. So I lovehearing that story. It does before ask you more about what you're doing today, though, I do have to ask,...

...because part of the reason that we'rekind of in a void of talent to it agree. Were approaching thatright if we don't manage just the right away, is because many don't seethat journey from when I was in elementary school to you know, go intorespondent right. It's not one of those hey, I want to be arisk manager instead of a you know, quarterback or a scientist. So sohow did it? So? So what did you anticipate yourself doing? Andthen how did you go, you know, as you left school, into theristmandament space? Sure, a great question. I don't think any littlekid, you know, wakes up thinking they're going to be an insurance suggester. That's going to be what their career path is, but it's often notpresented, even in college. Is kind of an opportunity. So I tooka, you know, a little bit different route. We started in theclaims department, or started in the claims department and you know in college that'snot presented as an opportunity. Most of the opportunities you hear about in insuranceare either on the underwriting side or things like that, or sales. Butclaims has been it's a very study. It's a consistent job. It's alwaysgoing to be there. You can make good money if you're if you aredoing your job correctly and you like the work. When I was a kidI thought I was going to be a lawyer. So this kind of pairsvery closely. I'd like the investigation. I like really digging in and gettingmy hands dirty and learning about each claim. is so different. So being ableto learn the intricacies of what and why and how to help. That'sreally what I've had a love affair with. I love of it. Very nice. Yeah, I think for those that can, and I see this, spend some time in the benefit space as well, if you can appreciatethe journey not necessarily being mapped out out of time, I think you canreally especially if you have a personality that thrives in that space. I thinkyou can really, you know, accomplish some things that you know, thatmaybe not have anticipated or even aspired to, you know otherwise. So that's great. So advocate rare health system. You know, I was going tosay that we're at the tail and middle. I don't know where we are withthis pandemics. I'll put that out there, but I do know thisbeing going on for at least the twenty months now. What's been the impactto, you know, your organization, to your employees? What's been theimpact from a workers conversation standpoint? How is this? How things spared fromthe health system perspective? Share how long do we have? It's been.It's been massive, it really has, not only from a workcomp standpoint,but you know, supporting those frontline workers is so imperative because if they're nothealthy and being able to take care of the sick patients, we have nothingleft. So our support, I think, on the work comp end and theteam member health and safety end is invaluable. We really need to understandthat that our supporting role is only helping the frontline workers who are doing thatreally hard job at day in and day out. Our claims volume has probablytripled in the past twenty months or so and my incredible team has been ableto stay within their space. We haven't had any increase in our inner numberof employees. We've been able to keep...

...the same number of employees within thedepartments and they've just handled it. They're incredibly resilient. My team is hasfantastic. So I've gotten very lucky that there's a group of very responsible,productive individuals that work in workers comp for me and that's kind of helped usbuild and be able to keep our heads above water, because this has beena really, really toughier yeah, that's amazing. That's that about just keepingthat core team and the core group in place throughout this. That's not commonthese days. It's a good host. I could have used a couple ofothers, but it happens. Coulda than that achievement that. Yeah, haveyou, from a an Organizat perspective? Have you, as it been anystruggle with classifying the classification of these covid related claims to specifically to your employeesand maybe even some of the you know, the the long term symptoms or coalmorbidities that have occurred? At which approach of you all taken? Ofyou taken a hey, you know, this is somewhat fluid. You know, we're going to assume there's a relation of correlation and move forward as awork complaim more. Has it been? More of it's not all it weunless it's clearly the find. You know it's related or not related. Whatdo you see yourself going in any particular direction? Yes, yes, advocateis has taken a very measured approach into which claims are being accepted in whichare not. Being a healthcare provider, I think the the legislature in bothWisconsin and Illinois have kind of given us guidelines about frontline workers. In Wisconsin, if you can trace it back to one patient or one coworker that hadcovid, that you can coint to that person and say that's likely where Igot it. That's an accepted work comp claim in Illinois. If you're workingwith a group of people that you think that was the exposure, it's likelygoing to be accepted. So due to the legislature and having kind of thepresumption of contagion, it's made the accepting and determining the the cause of thesecovid exposures a little bit easier than, I would say, though, thegeneral public. So follow questions to that. I mean, I know you knowthere's another variants out. We don't have a solid with confidence. Can'tsay what tomorrow, the next month holds, but at least for what you're you'replanning for. Where do you see how do you see the your organization, you individually continuing to plan for, prepare for potentially react to this?This this current norm, this new norm. Absolutely I think the vaccine is reallyand we've mandated the vaccine. Our deadline is coming up October fifteen.So every one of our employees, whether you stay at home, whether you'rea frontline employee or office employee, will have to get a covid vaccine andI think that is going to take big steps into reducing the number of covidexposures. The delta variant is really has...

...been devastating. It's those are thesickest that I've seen these claims come through, the sickest people, the youngest people. So it's it truly is devastating to see how it's impacting our teammembers and how it's impacting their lives, their families, their spouses. SoI think the vaccine really is going to move us into a direction. Thatword, we're going to be able to manage and and mitigate those. Thenumbers have gone down so thankfully we're not seeing as many catastrophic injuries, thehypoxic brain injuries or the paraplegia due to these strokes and things like that happenedvery early on in the pandemic and while they're still getting some of them arestill coming through, the numbers have dropped. That's great. That's yeah, positivesilver lining for sure. It's good to hear. Yeah, so let'sspeaking of positive out pivot a bit and see. You know. So Ihave to imagine that you've had some wins as well over the course of,you know, the past year or so. Anything that stands out to you thatsays you know, we did that, we did that well, proud ofthat, or that you're preparing for and you see the you know thehorizon and it looks good. Anything you call out. Yes, absolutely.My team has had so many it's we have a lot of time or wehave sometimes, so hopefully I can go through some of them. But we'vebeen able to do so much really during this exceptionally difficult time and the resiliencededication of my team has really driven that success. You know, we're inthe middle of global pandemic affecting the front line workers. So we are werebombed all the time, and we're also harmonizing two programs, the advocate ofIllinois side and the Wisconsin Aurora side. When they merged, I want tosay it was in two thousand and sixteen, but don't hold me to that,the two programs had to decide, you know, here's our philosophy overhere, here's our philosophy. How are they going to mash? So that'sbeen an ongoing issue for a couple of years. It's taken a lot ofa lot of really hard work. Also, in the middle of this we changebrokers and carriers and I'm the project manager for building out a new riskmanagement insurance platform. So we are doing everything all at once and my wonderfulteam has been really patient with me. Change is sometimes pretty difficult, it'sscary and when a lot of the areas of that job are changing kind ofall at the same time, it can create some uncertainty. But luckily ourteam has faith kind of in the big picture and trust in our management andleadership on why their changes need to occur. So our department really has been fosteringclose relationships with team member health and safety, with legal, with ouremployee health and knock health teams. So with so many balls in the airand just really, really proud of my team for being able to manage excelat not only their roles but also coordinating with other departments and being open tochange. So my motto has always been that our departments is kind of responsiblefor taking care of the sicker injured team...

...members so they can get back tocaring for our patients, and the team has really taken that and run withit. So what I'm hearing is managing the pandemic alone was it enough.You've taken off and he's someone that was not on turn over turn to youdid. Okay, Kudas to you. That's impressive. That's and it's,I think you know, kidding aside. I mean doing that given the changein environment that that I'm sure you will have gone through as well with,I'm sure many people mean you have more frontline workers, so maybe remote isnot as sick as free hasn't been as consistent for you over the past swiments. But regardless, managing through that environment and then also taking on what soundslike more 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 we find ourselveson more so than ever before. The natural breaks of old, whether itbe commutes or travel or what have you, those are gone. That your constantmeetings, constant go time. That's a lot to take on in thatperiod of time. It's that's impressive. Congratulations. Thank you. So,if you are are looking at the industry at a maybe more macro level andyou say, you know, I have eighteens experience. I've seen and donea little everything. You know, we're taking on new challenge is now.have their been things along the way that you said. You know, thisis I don't think individuals outside of this space really get it. You know, there's some misunderstandings or misconceptions about either or what we do, how weget it done or how we can improve it anything like that. So theygot to you. Yeah, absolutely, there's, you know, some somemisconception about the insurance industry and just insurance isn't always boring. Insurance involves somany different facets and partnerships with lawyers, doctors, judges and a place fromreally all walks of life. So every claim is different. One day youmay be handling a case of a traveling employee WHO's involved in like an autoaccident, and then the next claim could be a retail lost person, bunchand officer who is bit by a snake. I was hiding into shoplifters purse.So you never know what the day is going to give you and thoseclaim like. If you talk with insurance professionals, they have some incredible stories. Every single person that I've met in the industry has a crazy story likethat. So it's really interesting. If you ever seen the movie the incredibles, I have a five year old so Mr Incredible. His Day job,or is cover job, was an insurance handler and I think the preconception ofinsurance work is kind of a boring stadgy bland job isn't really accurate these days. Yeah, I totally agree with that. So now I did the snake's aquestion the stake story. Excuse me, was that intentional or is that justby chance? Well, I think we decided that they, the shoplifter, had the snake in the purse and then when the last prevention person wentto go find the item that they thought they had shoplifted, boom there's asnake there and it may have been a...

...des I don't know. That tothe claim that one. That's all I can tell you. I just camefrom the exotic pet store right and probably shoplifted down great point. But youyou're right, though. They the stories that are out there and even theI'd say the pathway to the injury, I mean, which is part ofthe story. It's just it's incredible, you know what. And then thenyou hear what in some individuals go through and that are Adam and about theirrecovery to you know, you hear those, those recovery stories that are just whenyou have people that go through amputations and permanent disabilities of sorts, ofpartial at least, and they're able to recover to a point where they areproductive, you know, citizens and some times, some cases more than theywere before. It's in power. So to your point on you know,it's often the industry is often seen in a certain light. I think thatthere's 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 interestedin inherent learning more, they really should or or see it as a potentialpathway, they really should, you know, investigate further, because there's a lotto be gained from it for sure. So is there anything out there thatyou see as hey, I need to fix this, like we needto fix this. You know, this is it's been this way or it'sat 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 withone technical thing that we have been struggling with. I think on a technicallegal end of things, there I believe there should be a cap on aperson of person as a whole benefit at a hundred percent total, not perinjury. So these frequent flyers, people who have multiple claims, can actuallystack these permanent disability ratings and end up earning more than a hundred percent oftheir entire body for a disability. It doesn't make make much sense on ayou know, logical sense. So it also incentivises them to kind of continuefiling claims. So I will keep it at that. No, so we'resome more audience is brand news of the space. So what you just describesomething they've never heard before. So expanding that a little bit for me sothat you're saying that they could have they could take advantage of a point withina claim that would exceed financially the return of where they were pre disability.Sure, so what not? Permanent Disability is is rated based on the bodypart that was injured, and this is both in Wisconsin and Illinois. Manas a whole or person as a whole to ssability is usually capped at aboutfive hundred weeks, and that's just the benefits that you would be paid outif you are completely disabiled disabled due to the work injury. So each bodypart, it sounds a little weird, but each body part, including likeyou know, little finger down to your toes, has a rating with thestate and this that's all state mandated. If you have a disability that givesyou a certain percentage, the doctor at...

...the end of your healing will sayyou had this back surgery. I think you have twenty percent permanent disability dueto this injury. Here's your writing and the Insurance Company pays out a certainamount 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 abody as a whole is rated at five hundred weeks, you shouldn't be ableto get six or seven hundred weeks of disability for several concurrent back injuries.But it's an opportunity, I think, for improvement. But the the statedoesn't always get it right. Neither state gets it right. Nobody gets itright all the time. So this an opportunity, I think, for beingable to cap it and put a little bit more pressure on the frequent flyersor the people who are, are, you know, career workers, compfilers. We do know those exists out there. Unfortunately, there are manypeople that are appropriately filing claims, have legitimate situations and injuries and then Ithink, just as in life, in generally have a vision. I'm goingto take advantage of the system. So that's that's good to know. It'sdefinitely get to know. So as we as we look forward, as youlook forward, you know, months, year or years down the road,is there 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 employees as they'regoing through a claim? Or if you just had a magic one and yousaid, Hey, if we could do this, you know, if wecould bring this from my my personal environment to this claim environment, it wouldtransform the industry, or anything like that out there that comes to mine.Yeah, you know, our our company has been fantastic about kind of lookingtowards the future and what what we can do to keep our employees safe andprevent injuries. We are currently building out a team member health and safety rolesand responsibility. Is kind of a whole new department that is going to bemore of the proactive let's prevent these injuries before they happen where comp is kindof a reactive in injury occurs and then then we step in. So theteam member health and safety program is designed to kind of look at those rootcause analysis, figure out why that happened, figure out if there's a hazard thatis evident in more than one location and let's go in and fix it. So the best claim is one that never gets filed. The best oneis when nobody gets injured in the first place. The second best claim isgetting it paid and appropriate medical treatment and having that person get back to theirpre injury status and their healed. That's the the very best solution. Ithink there used to be, you know, an old urban legend that the claimsadjusters would get a kick back or something for every denial that they couldcrank out, and that's not true. So it's you know, it's it'ssuper important to realize that ultimately the company wants the best for you, youknow, in ninety nine percent of the cases, so that we really arelooking towards the future and trying to prevent those injuries that can be catastrophic.We don't want them to happen in the...

...first place. So it's very excitingor director of team member, health and safety and workers compensation and our managerhave been fantastic and we're really excited to build that program Oh, excellent.I think we see more organizations, from my perspective, looking at ways thatthey can build out, you know, advocacy or preventative programs that may notexist to day to really get ahead of that what's typically been a reactive environment. So that's that's great to hear said. Well, thank you. Thank you. It's been a fantastic conversation to theresa. I'm sure they're going tobe folks out there that may want to get a hold of you and eitherask your question or invite you to a speaking engagement. In fact, Iknow you have a speaking engagement coming up around the evolving workforce. What's goingto be the four week close? What's going to be the theme of thatconversation? You have a couple different things that we're going through and working ona panel with a couple other talented ladies that we're really looking at how thethe the workforce has changed, the work from home versus in the office,the hybrid people. Also looking into what what covid has done for our industryas a whole what are we looking at a claim trends? What are welooking at a covid long callers? What type of Eighta accommodations would we needto consider for them if there are permanent disabilities that don't go away? Sothese are all things that we're going to discuss. That the Wisconsin work compfor him. I believe I'm speaking on the sixth, so next Wednesday,and we're really excited to kind of have that opportunity to have that that discussionwith a group of great professionals. Excellent. Yes, and if folks want toreach out to you otherwise, what's the best way to do that?Linkedin is great. You can find me under Theresa Clark Schmidt or you cansend me an email. I'm always available. Theresa Tche Er. Yes, adot Clark Cla rk at AAH Dot Org. What's three? So thankyou so much for your time. Love the conversation and love hearing your journeyand where you're going next within that story. So thank you and good luck witheverything. Thanks so much, Mark. It's been a pleasure. You've beenlistening to beyond the claim, a podcast for risk and claims leaders.To ensure you never miss an episode. Please subscribe to the show in yourfavorite podcast player, if you use apple podcast. We'd love for you togive us a quick rating for the show. Just tap the number of stars thatyou think the podcast deserves. Until next time, stay curious and keepinnovating.

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