The Connection Magazine AIM MUTUAL Spring 2019 | Page 25

WORKERS’ COMP CASES
The Cases That
Stay With You
They may inspire, disturb, or take unexpected turns. Sometimes it’s a
return-to-work story, or maybe it’s a complex case that taught you to pay
close attention. But for whatever reason, these claims linger, long after
they’re closed. We asked A.I.M. Mutual supervisors to share
a few of their past cases that resonated.
conducted a thorough analysis of the accident scene and assigned a
nurse case manager to ensure the employee received the best care
possible. I met with him while he was in the hospital to explain his
benefits. The employee underwent a long and painful rehabilitation.
We worked with the insured to facilitate a part-time return to work.
Ultimately, the employee progressed to his normal job with some minor
modifications.
Claim Handling with Compassion
By Andrew Burton, Claim Supervisor
THIS CLAIM involved a landscaper who had spent over 20 years
working in a family business. The employee was removing trees when
a branch fell onto his head and neck. The accident resulted in a spinal
cord injury. While undergoing diagnostic imaging for his work injury,
the doctors discovered a cancerous mass in his brain. Despite making
gains in therapy from the accident, the doctors determined he had
only had two-to-three months to live due to the tumor. Six months
post injury, the employee passed away.
I discuss this claim in training as it emphasizes the importance of
a good initial evaluation and communication. The case stays with me
as the injured worker made a point to tell me he had heard “negative”
things about workers’ compensation, but A.I.M. Mutual had changed his
perception for the better.
Adjusters are trained to use all the tools available to control the
direction of a claim. This claim was a harsh reminder that there are
times when our ability to control a positive outcome is limited. In
these moments, I’ve learned that you have to turn your attention to
the “little things” you can control.
The Strength of a Team
By Forrest MacDonald, Senior Claim Supervisor
THE CASE that has made a lasting impact on me involved a
construction worker who suffered a traumatic brain injury. The
employee was working in the basement of a home when he lost control
of a pneumatic nail gun and accidentally discharged a half-inch nail into
his left temple. He was found unresponsive by coworkers. He was med-
flighted to a local trauma center and underwent emergency surgery.
He endured speech, occupational, and physical therapies to improve
his functional capabilities and focused on strategies to facilitate skills
required for a return to work. Within six months of his traumatic injury,
the employee was able to progress to a work conditioning program,
pass his driving assessment, and return to work on modified duty.
We made prompt contact with the family, demonstrated
compassion, and ensured there was no uncertainty as to the
deliverable benefits. A patient advocate was assigned to coordinate
care and serve as a liaison between the practitioners and the family.
While this claim took a tragic turn, I am confident that we provided
comfort to the employee’s family during their time of grief. At the
end of the day, it is the little things that we do on a claim that make
a difference.
Changing Perceptions on Workers’ Compensation
By Cathy McKeever, Claim Supervisor
The claim team coordinated the day-to-day activity and made sure
that nothing fell through the cracks. Our Regional Claim Specialist
met with the injured worker and his wife to discuss his benefits.
Our on-site nurse case manager coordinated all of the extensive
medical treatment. There was terrific communication. Our efforts
complemented one another as we were all committed to the same
goal of helping this gentleman get the best medical treatment to
get his life back and return to work. It is a great example of what
can be accomplished when everyone works together as a team.
MY MOST memorable claim involved a gentleman injured when he
was delivering an industrial air conditioner to a job site. The container
slipped off of the rigging and landed on his right leg, fracturing it in
several places. He was airlifted to a hospital and underwent several
surgeries.
Through our initial investigation, we learned that he had lost his left
leg—from the knee down—in a motorcycle accident years before. We
Part 2 will be featured in the fall edition of The Connection.
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