The Connection Magazine The Connection Magazine Spring 2018 | Page 7

“IN WORKERS’ COMPENSATION
CLAIMS, COMMUNICATION
CAN BE A GAME CHANGER.
KEEP ALL THE CHANNELS
OPEN. EVEN IN THE MOST
DIFFICULT CASES, OUR
WORKERS’ COMPENSATION
PARTNERSHIP CAN HELP
BRING ABOUT THE OUTCOME
WE ARE ALL HOPING FOR.”
notified of a serious accident involving three
employees hurt in a power plant explosion.
The employees’ medical status was unknown.
I reached the owner who was grateful for the
call, and we met early the next morning at the
site.
A.IM. Mutual’s Role: Due to the gravity of
the accident, we enlisted an outside engineer
to join us. With our preliminary investigation
under way, the owner and I discussed
the status of each employee. One was
transferred to a Burn Unit while the other
two had already been discharged. Next, we
assigned nurse case management to assist
with navigating their medical care. We were
able to reach some family members, assuring
them that their loved ones would be well-
taken care of and they could call us anytime.
The owner worked tirelessly each day
to maintain an open line of communication
with each injured worker. With face-to-face
communication, phone calls, and, yes, some
texting, he made himself available.
In these cases, an insured is called upon
to be four things: employer, psychologist,
mentor to injured workers, and gatekeeper
to the insurer. A s the claim liaison, I am also
a sounding board, knowing the process
is new and sometimes frustrating. The
owner and I spoke daily. The most seriously
injured employee regained full use of his
hands and arms, which was initially in doubt.
Each employee recovered, a tribute to the
business owner who stayed involved with the
workers and their families throughout the
ordeal.
Workplace Accident – Our “Miracle” Case
Background: “Fred,” a thirty-eight-year-
old processing engineer, fell from a fifteen-
foot ladder onto a concrete floor, suffering a
severe head injury.
A.IM. Mutual’s Role: I advised the insured’s
HR manager to preserve the scene, got some
preliminary facts, and informed our claim
supervisor, who in turn sent a nurse case
manager to the hospital.
At the accident site, I got more details and
took photographs for documentation and for
any potential third-party claim. Recorded
statements are always hard to elicit from
witnesses in the aftermath of a serious
accident but important to get early on. At the
hospital, I met with Fred’s wife, explaining
that her husband would get the best possible
medical care and gave her contact numbers
for the A.I.M. Mutual team.
Fred was unconscious for an extended
period of time, and his prognosis was poor. We
joined with our policyholder to further help
the family, reaching out to the employee’s
community to organize babysitters and
transportation to and from the hospital.
Meantime, word went out to coworkers and
parishioners at Fred’s church who all helped
prepare daily meals for Fred’s family.
Nurse case management and A.I.M.
Mutual’s partnership with Best Doctors
Occupational Health Institute almost
certainly made a difference. The case
manager reviewed medical records upon
admission, arranged medical referrals, and
expedited treatment. Against the odds,
Fred began to recover, and after five months,
returned to work wearing a halo to protect
his head. In many ways, it was a miracle case,
made possible, I believe, through a dedicated,
collaborative effort.
What You Can Do in the Aftermath of
a Traumatic Incident
In workers’ compensation claims,
communication can be a game changer.
Keep all the channels open. Even in the most
difficult cases, our workers’ compensation
partnership can help bring about the outcome
we are all hoping for. Take the following steps
after any traumatic incident in the workplace:
• Call 911 to ensure your employee is
taken care of immediately.
• Rope off the accident scene. Shut
down any machinery.
7
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Contact your adjuster and/or
Regional Claim Specialist by phone
and file the claim immediately. We
will respond quickly, assign a nurse
case manager, and contact your injury
prevention consultant.
Conduct your initial investigation.
Stay involved. Communicate with
your injured workers and their
families until the injured workers
return to work and the claim is closed.
Make meals. Offer to help with
transportation. Connect with injured
workers’ communities.
Start thinking about modified duty
from day one—it’s never too early.
Just call us if you think you don’t have
modified duty. You do and we’ll help
you.
Work with your Injury Prevention and
Worksite Wellness consultant.
ABOUT
DOTTIE TATOIAN
DOTTIE TATOIAN is a Senior Regional
Claim Specialist for A.I.M. Mutual.
A frequent guest speaker on claim
investigation, claim handling, fraud
identification, and settlement
negotiation, Dottie conducts training
sessions and facilitates successful
return-to-work plans for injured
workers. She has worked for the
Massachusetts Trial Court and has a
personal background in deaf culture
and American Sign Language.