Beyond the Claim
Beyond the Claim

Episode 2 · 6 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 never gets 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 having that person get back to their pre injury status and their healed. You're listening to beyond the claim, the show for forward thinking risk and claims professionals curious about the latest industry trends, winning strategies and stories from influential leaders. Let's dive in. Hello and welcome to this episode of beyond the claim with your host Mark Cunningham, chief sales and marketing officer with broad spire. Today I have with me Teresa Clark. Teresa is a manage of workers compensation at Advocate Health Aurora. Teresa, welcome, thanks so much for having me. I appreciate 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 row sure? Advocate of Urura health is a group of hospitals and medical facilities throughout Wisconsin and Illinois. We support about seventy seven thousand employees throughout the the two different jurisdiction. So my main role is management and mitigation of work comp claims throughout the organization. So I am curious. I asked folks, you know, for their kind of their backstory as they we get into our conversation and and and looking through your profile and Bios, I saw a path that I think I see some sons but I don't know that many really leverage to take advantage of and it's just I think it's impressive to see the journey that folks have within the risk space. I think you're your first job within a risk space was in the adjuster capacity. That right correct. Yeah, I graduated from uw Whitewater and two thousand and three I think, and my first job out of college was at a Wisconsin insurance carrier kind of adjusting claims throughout several different jurisdictions and then after that time in the adjuster realm, I got my property and casualty, health, life and accident producer license and kind of sold some TP services. So I went over to the agency side. Following that I worked on the employer side for a national retail clothing company kind of managing their workers count program and it's at times twenty six different jurisdictions and my most recent 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 is kind of a perfect serendipitous, you know, resolution for eighteen years of experience adjusting and on the agency side and with tpas. That's fantastic, fantastic. I know we were going through or approaching our silver tsunami, apparently, and I think there's a there's a need for many to understand that there is a pathway, a journey from many of us to within this risk space and it can take on different forms and their different facets to it. So I love hearing 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're kind of in a void of talent to it agree. Were approaching that right if we don't manage just the right away, is because many don't see that journey from when I was in elementary school to you know, go into respondent right. It's not one of those hey, I want to be a risk manager instead of a you know, quarterback or a scientist. So so how did it? So? So what did you anticipate yourself doing? And then how did you go, you know, as you left school, into the ristmandament space? Sure, a great question. I don't think any little kid, 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 not presented, even in college. Is kind of an opportunity. So I took a, you know, a little bit different route. We started in the claims department, or started in the claims department and you know in college that's not presented as an opportunity. Most of the opportunities you hear about in insurance are either on the underwriting side or things like that, or sales. But claims has been it's a very study. It's a consistent job. It's always going to be there. You can make good money if you're if you are doing your job correctly and you like the work. When I was a kid I thought I was going to be a lawyer. So this kind of pairs very closely. I'd like the investigation. I like really digging in and getting my hands dirty and learning about each claim. is so different. So being able to learn the intricacies of what and why and how to help. That's really 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 appreciate the journey not necessarily being mapped out out of time, I think you can really especially if you have a personality that thrives in that space. I think you can really, you know, accomplish some things that you know, that maybe not have anticipated or even aspired to, you know otherwise. So that's great. So advocate rare health system. You know, I was going to say that we're at the tail and middle. I don't know where we are with this pandemics. I'll put that out there, but I do know this being going on for at least the twenty months now. What's been the impact to, you know, your organization, to your employees? What's been the impact from a workers conversation standpoint? How is this? How things spared from the 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 not healthy and being able to take care of the sick patients, we have nothing left. So our support, I think, on the work comp end and the team member health and safety end is invaluable. We really need to understand that that our supporting role is only helping the frontline workers who are doing that really hard job at day in and day out. Our claims volume has probably tripled in the past twenty months or so and my incredible team has been able to stay within their space. We haven't had any increase in our inner number of employees. We've been able to keep...

...the same number of employees within the departments and they've just handled it. They're incredibly resilient. My team is has fantastic. 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 us build and be able to keep our heads above water, because this has been a really, really toughier yeah, that's amazing. That's that about just keeping that core team and the core group in place throughout this. That's not common these days. It's a good host. I could have used a couple of others, but it happens. Coulda than that achievement that. Yeah, have you, from a an Organizat perspective? Have you, as it been any struggle with classifying the classification of these covid related claims to specifically to your employees and maybe even some of the you know, the the long term symptoms or coal morbidities that have occurred? At which approach of you all taken? Of you 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 a work complaim more. Has it been? More of it's not all it we unless it's clearly the find. You know it's related or not related. What do you see yourself going in any particular direction? Yes, yes, advocate is has taken a very measured approach into which claims are being accepted in which are not. Being a healthcare provider, I think the the legislature in both Wisconsin 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 had covid, that you can coint to that person and say that's likely where I got it. That's an accepted work comp claim in Illinois. If you're working with a group of people that you think that was the exposure, it's likely going to be accepted. So due to the legislature and having kind of the presumption of contagion, it's made the accepting and determining the the cause of these covid exposures a little bit easier than, I would say, though, the general public. So follow questions to that. I mean, I know you know there's another variants out. We don't have a solid with confidence. Can't say what tomorrow, the next month holds, but at least for what you're you're planning 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 really and 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're a frontline employee or office employee, will have to get a covid vaccine and I think that is going to take big steps into reducing the number of covid exposures. The delta variant is really has...

...been devastating. It's those are the sickest 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 team members and how it's impacting their lives, their families, their spouses. So I think the vaccine really is going to move us into a 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 many catastrophic injuries, the hypoxic brain injuries or the paraplegia due to these strokes and things like that happened very early on in the pandemic and while they're still getting some of them are still coming through, the numbers have dropped. That's great. That's yeah, positive silver lining for sure. It's good to hear. Yeah, so let's speaking of positive out pivot a bit and see. You know. So I have 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 that says you know, we did that, we did that well, proud of that, or that you're preparing for and you see the you know the horizon 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 we have sometimes, so hopefully I can go through some of them. But we've been able to do so much really during this exceptionally difficult time and the resilience dedication of my team has really driven that success. You know, we're in the middle of global pandemic affecting the front line workers. So we are were bombed all the time, and we're also harmonizing two programs, the advocate of Illinois side and the Wisconsin Aurora side. When they merged, I want to say 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 over here, here's our philosophy. How are they going to mash? So that's been an ongoing issue for a couple of years. It's taken a lot of a lot of really hard work. Also, in the middle of this we change brokers and carriers and I'm the project manager for building out a new risk management insurance platform. So we are doing everything all at once and my wonderful team has been really patient with me. Change is sometimes pretty difficult, it's scary and when a lot of the areas of that job are changing kind of all at the same time, it can create some uncertainty. But luckily our team has faith kind of in the big picture and trust in our management and leadership on why their changes need to occur. So our department really has been fostering close relationships with team member health and safety, with legal, with our employee health and knock health teams. So with so many balls in the air and just really, really proud of my team for being able to manage excel at not only their roles but also coordinating with other departments and being open to change. So my motto has always been that our departments is kind of responsible for taking care of the sicker injured team...

...members so they can get back to caring for our patients, and the team has really taken that and run with it. 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 you did. Okay, Kudas to you. That's impressive. That's and it's, I think you know, kidding aside. I mean doing that given the change in 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 is not 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 sounds like 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 ourselves on more so than ever before. The natural breaks of old, whether it be commutes or travel or what have you, those are gone. That your constant meetings, constant go time. That's a lot to take on in that period 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 and you say, you know, I have eighteens experience. I've seen and done a little everything. You know, we're taking on new challenge is now. have their been things along the way that you said. You know, this is 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 we get it done or how we can improve it anything like that. So they got to you. Yeah, absolutely, there's, you know, some some misconception about the insurance industry and just insurance isn't always boring. Insurance involves so many different facets and partnerships with lawyers, doctors, judges and a place from really all walks of life. So every claim is different. One day you may be handling a case of a traveling employee WHO's involved in like an auto accident, and then the next claim could be a retail lost person, bunch and 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 those claim 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 like that. 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 of insurance 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 a question the stake story. Excuse me, was that intentional or is that just by chance? Well, I think we decided that they, the shoplifter, had the snake in the purse and then when the last prevention person went to go find the item that they thought they had shoplifted, boom there's a snake there and it may have been a...

...des I don't know. That to the claim that one. That's all I can tell you. I just came from the exotic pet store right and probably shoplifted down great point. But you you're right, though. They the stories that are out there and even the I'd say the pathway to the injury, I mean, which is 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 and about their recovery to you know, you hear those, those recovery stories that are just when you have people that go through amputations and permanent disabilities of sorts, of partial at least, and they're able to recover to a point where they are productive, you know, citizens and some times, some cases more than they were 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 that there's just there's so much reward that can come out of it various roles in positions. So yeah, I agree that if there's, if anyone is interested in inherent learning more, they really should or or see it as a potential pathway, they really should, you know, investigate further, because there's a lot to be gained from it for sure. So is there anything out there that you see as hey, I need to fix this, like we need to fix this. You know, this is it's been this way or it's at risk of going this way and and this is something that I would love to 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 we have been struggling with. I think on a technical legal end of things, there I believe there should be a cap on a person of person as a whole benefit at a hundred percent total, not per injury. So these frequent flyers, people who have multiple claims, can actually stack these permanent disability ratings and end up earning more than a hundred percent of their entire body for a disability. It doesn't make make much sense on a you know, logical sense. So it also incentivises them to kind of continue filing claims. So I will keep it at that. No, so we're some more audience is brand news of the space. So what you just describe something they've never heard before. So expanding that a little bit for me so that you're saying that they could have they could take advantage of a point within a 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 body part that was injured, and this is both in Wisconsin and Illinois. Man as a whole or person as a whole to ssability is usually capped at about five hundred weeks, and that's just the benefits that you would be paid out if you are completely disabiled disabled due to the work injury. So each body part, it sounds a little weird, but each body part, including like you know, little finger down to your toes, has a rating with the state and this that's all state mandated. If you have a disability that gives you a certain percentage, the doctor at...

...the end of your healing will say you had this back surgery. I think you have twenty percent permanent disability due to this injury. Here's your writing and the Insurance Company pays out a certain amount of money based on your wages. You can stack that to more than a hundred percent, which to me that doesn't make sense. If if a body as a whole is rated at five hundred weeks, you shouldn't be able to 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 state doesn't always get it right. Neither state gets it right. Nobody gets it right all the time. So this an opportunity, I think, for being able to cap it and put a 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 out there. Unfortunately, there are many people that are appropriately filing claims, have legitimate situations and injuries and then I think, just as in life, in generally have a vision. I'm going to take advantage of the system. So that's that's good to know. It's definitely get to know. So as we as we look forward, as you look 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 you do your job better or that would improve the process for your employees as they're going through a claim? Or if you just had a magic one and you said, Hey, if we could do this, you know, if we could bring this from my my personal environment to this claim environment, it would transform the industry, or anything like that out there that comes to mine. Yeah, you know, our our company has been fantastic about kind of looking towards the future and what what we can do to keep our employees safe and prevent injuries. We are currently building out a team member health and safety roles and responsibility. Is kind of a whole new department that is going to be more of the proactive let's prevent these injuries before they happen where comp is kind of a reactive in injury occurs and then then we step in. So the team member health and safety program is designed to kind of look at those root cause analysis, figure out why that happened, figure out if there's a hazard that is 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 one is when nobody gets injured in the first place. The second best claim is getting it paid and appropriate medical treatment and having that person get back to their pre injury status and their healed. That's the the very best solution. I think there used to be, you know, an old urban legend that the claims adjusters would get a kick back or something for every denial that they could crank out, and that's not true. So it's you know, it's it's super important to realize that ultimately the company wants the best for you, you know, in ninety nine percent of the cases, so that we really are looking 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 exciting or director of team member, health and safety and workers compensation and our manager have 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 that they can build out, you know, advocacy or preventative programs that may not exist 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 to be folks out there that may want to get a hold of you and either ask your question or invite you to a speaking engagement. In fact, I know you have a speaking engagement coming up around the evolving workforce. What's going to be the four week close? What's going to be the theme of that conversation? You have a couple different things that we're going through and working on a panel with a couple other talented ladies that we're really looking at how the the 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 industry as a whole what are we looking at a claim trends? What are we looking at a covid long callers? What type of Eighta accommodations would we need to consider for them if there are permanent disabilities that don't go away? So these are all things that we're going to discuss. That the Wisconsin work comp for 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 discussion with a group of great professionals. Excellent. Yes, and if folks want to reach 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 can send me an email. I'm always available. Theresa Tche Er. Yes, a dot Clark Cla rk at AAH Dot Org. What's three? So thank you so much for your time. Love the conversation and love hearing your journey and where you're going next within that story. So thank you and good luck with everything. Thanks so much, Mark. It's been a pleasure. You've been listening to beyond the claim, a podcast for risk and claims leaders. To ensure you never miss an episode. Please subscribe to the show in your favorite podcast player, if you use apple podcast. We'd love for you to give us a quick rating for the show. Just tap the number of stars that you think the podcast deserves. Until next time, stay curious and keep innovating.

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