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From emotional intelligence to AI, we keep you covered at WorkersCompensation.com
Adopting Emotional Intelligence in Workers’ Compensation: The Challenge of Holding Two Truths
Sarasota, FL (WorkersCompensation.com) -- In the workers' compensation industry, the focus is often on physical injuries and the procedures necessary to address them. However, one essential aspect is frequently overlooked: emotional intelligence (EI). Emotional intelligence, the ability to recognize, understand, and manage your and others' emotions, is essential in this field. Yet many in the industry—adjusters, employers, and other stakeholders—struggle to adopt it. This difficulty often comes from an inability to remember two truths simultaneously: an injured worker may be injured and still have a life outside his injury. Understanding and addressing this challenge is essential to improving outcomes for injured workers and the overall effectiveness of the workers' compensation system.
Understanding Emotional Intelligence
Emotional intelligence comprises several components: self-awareness, self-regulation, motivation, empathy, and social skills. These elements are crucial in workers' compensation, as understanding and addressing injured workers' emotional and psychological needs can significantly impact their recovery and overall well-being. Self-awareness involves recognizing one's emotions and effects, while self-regulation involves appropriately managing these emotions. Motivation refers to the desire to achieve goals despite setbacks, and empathy consists of understanding and sharing the feelings of others. Social skills include the ability to manage relationships and deal with social complexities. Despite its importance, emotional intelligence is often neglected in favor of more concrete, physical aspects of recovery, resulting in a gap in comprehensive care.
The Nature of Workers' Compensation
The workers' compensation industry is primarily process-oriented and bureaucratic, focusing heavily on physical recovery and claim resolution. This traditional approach, while necessary, may lead to a narrow focus that needs to include the holistic needs of the worker. Insurance adjusters and employers are trained to assess physical injuries, but they often lack the training to manage these injuries' emotional and psychological effects. As a result, the industry treats injuries as isolated events rather than part of a broader context involving the worker's entire life. This focus on the physical may inadvertently dehumanize the injured worker, reducing them to a case number or claim rather than recognizing them as a person with complex needs.
The Duality of the Injured Worker’s Experience
Injured workers are more than just their injuries. They have lives, families, and identities outside of work. An injury can profoundly impact a person's mental health, personal identity, and life beyond the workplace. Recognizing this dual impact is crucial for providing comprehensive care and support. However, many involved parties, such as adjusters and employers, struggle to understand the non-physical aspects of injuries due to stereotypes and misconceptions about injured workers. These misconceptions can result in a lack of support for the emotional and psychological challenges that come with physical injuries, hindering the recovery process and the overall well-being of the worker.
Challenges of Embracing Emotional Intelligence
The insurance industry faces several challenges in addressing injuries' psychological and emotional aspects. Cultural and institutional barriers, personal biases, and systemic issues contribute to this problem.
Cultural and Institutional Barriers: The industry tends to prioritize physical improvement over emotional intelligence training, leading to a need for more emphasis on the psychological and emotional aspects of recovery. This norm prioritizes efficiency and cost-saving measures over holistic care. Resistance to change within institutions can also hinder the adoption of new practices incorporating emotional intelligence. Overcoming these barriers requires a concerted effort to shift the industry's values and priorities toward a more empathetic and holistic approach.
Personal Biases and Viewpoints: Many adjusters and employers struggle to empathize with the emotional experiences of injured workers, often due to the stereotype that they are overly dramatic or fake. These biases can lead to a dismissive attitude toward the psychological and emotional aspects of injuries, further isolating injured workers. Addressing these biases requires education and awareness initiatives that highlight the importance of emotional intelligence in understanding the full scope of an injured worker's experience.
Systemic Issues: The pressure for quick solutions and cost-saving measures often emphasizes efficiency over empathy. Limited resources for comprehensive care further exacerbate this problem. Tight deadlines, high workloads, and budgetary constraints make prioritizing emotional intelligence in the claims process difficult. The industry must advocate for policies and practices that allocate resources to holistic care and provide adequate training and support to adjusters and employers to integrate emotional intelligence into their daily interactions with injured workers.
The Importance of Holding Two Truths
To truly support injured workers, the industry must acknowledge both the injury and the person's life beyond it. A holistic approach can lead to better results, improved relationships, and enhanced employee well-being. Concrete examples and case studies have demonstrated that incorporating emotional intelligence into care practices leads to more effective and compassionate support. By recognizing the complexity of an injured worker's experience, the industry can create a more empathetic and supportive environment. This shift in perspective benefits the employee and contributes to a more efficient and effective workers' compensation system overall.
Strategies for Integrating Emotional Intelligence
Training and Education: Implementing emotional intelligence training programs for adjusters, employers, and other stakeholders can increase awareness and improve skills in managing injuries' emotional and psychological aspects. These programs can provide practical tools and strategies for integrating emotional intelligence into everyday interactions. Regular training sessions, workshops, and seminars can reinforce the importance of emotional intelligence and keep it at the forefront of industry practices. Additionally, integrating emotional intelligence into certification and continuing education requirements can ensure that all professionals in the field have the necessary skills.
Policy and Practice Changes: Encouraging a more holistic approach to injury management includes adopting policies prioritizing emotional support and comprehensive care. Providing psychological and emotional support resources is essential. Policies should include mental health services as part of workers' compensation benefits. Regular screenings, mental health assessments, and access to counseling services can significantly improve the support provided to injured workers. By integrating these elements into standard processes, the industry can ensure that emotional intelligence becomes essential to the care process.
Foster a Culture of Empathy: Fostering open communication and understanding within the industry is essential. Recognizing and rewarding empathetic behavior can help shift the culture toward greater emotional intelligence. Creating a supportive work environment where empathy is valued and encouraged can lead to more meaningful interactions between adjusters, employers, and injured workers. Initiatives such as employee recognition programs, peer support groups, and mentoring opportunities can reinforce the importance of empathy. The industry can create a more compassionate and effective system by fostering a culture that prioritizes emotional intelligence.
Behavioral Action: Holding Two Truths
Emotional intelligence is crucial in every aspect of the workers' compensation industry. The industry can provide better support and care by acknowledging two truths – that an injured worker can be injured and still have a life outside of their injury. Shifting mindset towards embracing emotional intelligence will lead to better outcomes for everyone involved. Now is the time for the industry to take action and integrate emotional intelligence into its operations. This change will not only benefit injured workers but will also improve the overall efficiency and humanity of the workers' compensation system.
Do You Know the Rule? N.Y. Presumption of Compensability for Workplace Assaults
Chris Parker
Albany, NY (WorkersCompensation.com) -- In New York, it’s presumed that an injury which occurs in the course of work also arises out of employment and is thus compensable under the state’s workers’ compensation law. That presumption applies equally to workplace assaults.
Compensability of injuries
To be compensable under New York’’s workers’ compensation law, an injury must have arisen out of and in the course of a worker's employment. When that’s the case, the employee’s sole remedy is workers’ compensation; the exclusivity provision generally bars the employee from suing the employer for negligence.
Injuries that occur in the course of employment - rebuttable presumption
There is a rebuttable presumption set forth in Workers' Compensation Law § 21(1), which provides that when an injury occurs in the course of a worker's employment, it is presumed to arise out of that worker's employment and therefore is compensable, absent substantial evidence to the contrary. Thus, a court, barring convincing evidence to the contrary, will assume that the injury flowed as a natural consequence of the employee's duties.
Applicability of presumption to assaults
In determining whether a victim of an assault at work is entitled to workers' compensation benefits, the test is whether the assault originated in work-related differences or from purely personal animosity between the assailant and victim.
However, the presumption applies to such assaults. It’s up to the employer to overcome that presumption by presenting substantial evidence establishing that it was not the workplace itself that exposed the employee to harm.
In some cases, there may be no evidence of what motivated someone to commit the assault in the workplace. But the fact that the assailant’s motives are a mystery doesn’t on its own alter the presumption that the assault arose out of work. That presumption still applies, and, if substantial evidence to the contrary is not presented, will in most cases mean that the employee’s sole remedy is workers’ compensation – meaning he is out of luck if he wants to sue his employer for damages in tort.
Case examples
Timperio v. Bronx-Lebanon Hosp. Ctr., No. 46 (N.Y. 05/16/24): Because there was no evidence as to why a coworker shot a medical resident he had never met at the hospital where they worked, it was presumed that the resident’s injury arose out of his employment.
Rosen v First Manhattan Bank, 84 N.Y.2d 856 (N.Y. 1994): Given evidence that the victim and assailant were co-workers who may have been engaged in a dispute over a loan of money — a practice which was condoned by the employer — and that the parties had no social ties outside of work, the police investigator's testimony that the assault was motivated by robbery was insufficient to overcome the statutory presumption that the dispute was work-related.
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Vendor Killed at PGA Event, Golfer Arrested after Assaulting Officers
Louisville, KY (WorkersCompensation.com) – While the golf world reeled on Monday over the arrest of one of the country’s top golfers prior to the PGA Championship, most overlooked the death that preceded it.
On Friday, May 17, Louisville resident John Mills was struck by a shuttle bus outside of Valhalla Golf Club where the championship tournament was scheduled to occur later that day.
Officials said Mills was attempting to cross Shelbyville Road around 5 a.m. He was working as a vendor at the championship, and was in the bus lane when he was hit by the shuttle bus. Officials with the Louisville Metro Police Department said he died at the scene.
"LMPD expresses its sincere condolences to the family of the individual who died as a result of that collision,” the police department said. “All lanes of traffic at the scene were closed while the fatality investigation occurred. LMPD personnel were also directing traffic around the scene. While an officer was directing traffic, an encounter with a motorist attempting to make entry into a restricted area ultimately led to the driver being arrested. We are in the process of conducting a thorough investigation. We are appreciative that all parties involved are fully cooperating.”
PGA of America also released a statement soon after the crash.
"This morning we were devastated to learn that a worker with one of our vendors was tragically struck and killed by a shuttle bus outside Valhalla Golf Club,” the PGA said in a statement. “This is heartbreaking to all of us involved with the PGA Championship. We extend our sincere condolences to their family and loved ones.”
Louisville Mayor Craig Greenberg’s office also expressed its sympathies.
"This morning, our city experienced a tragic accident that took the life of John Mills, a Louisvillian who will be greatly missed by his family and our community. Our focus is on this family who lost their loved one. I have spoken with members of Mr. Mills’ family to convey our city’s condolences."
By 6 a.m., traffic was backed up around the golf club as police investigated. It was then that golfer Scottie Scheffler was arrested for assaulting an officer, among other charges.
While officials said police and security presence outside of a major championship is common. One PGA Tour swing coach told the New York Times driving by a police presence is something they do on a regular basis.
Scheffler was attempting to get to the golf club when police said he illegally bypassed the scene of Mills death. Police said Scheffler failed to stop when ordered to by Louisville Metro Police Department Detective Bryan Gillis. The officer then attached himself to Scheffler’s car. According to the police report, Scheffler continued to move forward, “dragging Detective Gillis to the ground.” Jeff Darlington, an ESPN NFL reporter assigned to cover the tournament, was on the scene and reported that Scheffler’s vehicle moved 10 to 20 yards before it came to a final stop.
Police said the officer was dragged “to the ground” by the car and suffered “pain, swelling and abrasions to his left wrist” when the vehicle accelerated forward. The police department said Gillis’ uniform was also irreparably damaged.
The officer was sent to the hospital.
A spokesman for Greenberg, Kevin Trager, said there was no police body camera video of the incident as the officer was directing traffic at the time and it is not policy for officers directing traffic to record video with their body cameras.
Scheffler’s attorney, Steve Romines, told the New York Times that Scheffler was originally instructed to go in and that the officer directing traffic was not part of the event traffic detail.
“So that’s where the miscommunication arose and that’s why we’re here,” Romines said Friday morning.
Darlington said when Scheffler did stop, Scheffler lowered his window and the officer reached in, grabbed Scheffler’s arm and pulled the door open. Darlington said the officer then put Scheffler in handcuffs and pushed him against the car. Video filmed by Darlington showed Scheffler turned to him and said, “Can you help?”
Another officer is shown telling Darlington, “You need to get out of the way. Right now, he’s going to jail, and there’s nothing you can do about it.”
He was charged with multiple counts, including second-degree assault of a police officer and reckless driving.
Scheffler was the heavy favorite coming into the tournament following a string of wins in various golf tournaments. On Thursday, Scheffler had won four out of five of the tournaments he entered, including the Masters’ last month in Augusta, Georgia.
He was released later that day in time for his 10 a.m. tee time.
Scheffler said he never intended to break any traffic laws, and said the events that led to his arrest were a “big misunderstanding.” His arraignment has been set for June 3 in Louisville.
How AI Can Improve Treatment & Cost Forecasting Accuracy Within the Medicare Set-Aside Process
Kim Wiswell , Director of Client Services, Embedded AI, Gradient AI
Medicare Set-Aside Arrangements (MSAs) are an important part of workers’ compensation programs and assist in earmarking settlement funds to cover future medical expenses stemming from workplace injury claims. However, it can sometimes be challenging to forecast treatments and accurately predict costs.
The treatment and drugs included in the cost projection tables within an MSA are drawn from medical records, as well as past medical history. Given the number of medical reports associated with older claims, review of these records can be a lengthy process, often taking several hours or more. In the past, however, this was the only method of ensuring all future treatment recommendations were identified. But now, AI-assisted record review has emerged as a game changing approach.
Challenges in MSA Treatment Forecasting and Cost Estimations
Treatment Forecasting Inefficiencies - The current MSA process is laborious. First, a specialized allocator physically goes through the injured worker’s medical records, creating a summary of the injury and the medical treatment. For each treatment, the allocator must determine whether the recommended treatment has been provided to the injured worker. Any unfulfilled recommendations must be included in the MSA. Next, a treatment plan is developed based on physician recommendations for specific treatments such as surgeries, diagnostic testing, hospitalizations, etc., as well as treatment corresponding to CMS’s standardized guidelines. Last, the allocator prices the services and drugs under the treatment plan using state fee schedules and other pricing resources specified by CMS and recommends an MSA amount for the claim.
All of this can take several days to more than a week, which unfortunately leads to delays in claim closure and settlement funds being paid to the injured worker. In addition, the existing approach often leads to unpleasant surprises for claims managers. Unrecognized treatment recommendations often, consequently, increase the overall MSA amount, sometimes making the settlement impossible.
Cost Projection Inaccuracies – It is challenging to accurately estimate future medical costs within the current MSA framework. Most services are priced out based on state workers’ compensation fee schedules or, when unavailable, usual, customary and reasonable (UCR) fees for the jurisdiction. As fee schedules are unique to each state, and fees are updated as often as quarterly, determining the correct pricing can be a complex process. Also, as the claimant’s medical condition and health status change over time, often necessitating new and different treatments, the amount allocated in an MSA may not accurately reflect the future funds needed. Compounding this, CMS requires MSAs associated with settlements to have been done within the past six months. After this point, they are considered stale-dated, leading to additional costs for the claims payer, both for multiple MSA updates and increasing treatment fees over the course of lengthy settlement negotiations and proceedings.
AI Solutions Address These Challenges and Enhance MSA Management
AI solutions can significantly improve MSA operations by addressing inefficiencies in the identification of future medical treatments. By analyzing vast amounts of medical reports, generative AI can detect treatment recommendations within the records, compare them to structured medical payment data for treatment already provided to the injured worker, and flag treatment yet to be provided. These insights allow allocators to readily identify services and drugs for inclusion in the MSA.
For example, by analyzing historical treatment data, AI can determine specific treatment frequencies for evaluations, therapy, and surgical revisions, as well as the injured worker’s current drug regimen. This data helps MSA allocators make better decisions when forecasting treatment and drugs, which leads to improved cost savings and more accurate funding of the MSA.
MSA cost projections can also be more accurate by leveraging AI. Predictive analytics can monitor trends, analyzing information in real time. In cases where settlement hasn’t occurred, it can automatically recommend changes to the MSA to meet the changing medical conditions and related treatment needs. AI also notes important things that can change, such as evolving treatment plans, how medication is used, and how much things cost. It can also identify and flag escalating cost-drivers such as costly surgeries or procedures early on with suggested actions on how to address each cost driver to mitigate costs.
As healthcare continues to evolve, AI will become even more critical to streamlining operations to achieve better outcomes and ensuring the long-term success of workers' compensation programs.