February 3, 2025 • 32 mins
In this rebroadcast episode, ADJUSTED welcomes Karyl Bierwagen, Senior Catastrophic Resolution Specialist with Berkley Industrial Comp. In this episode, Karyl delves into the art of conducting a successful investigation of a workers' comp claim. She highlights the importance of balancing technical knowledge with empathy to navigate the complexities of claims investigations effectively.
Join us as we explore:
- Understanding Compensability: Grasp the essentials of what makes a claim compensable.
- Empathy in Investigations: Learn why empathy is crucial in the investigation process.
- Thorough Evidence Gathering: Discover the importance of collecting comprehensive evidence, including witness accounts.
- Technology's Role: See how technology can enhance investigative efforts.
- Tips for New Adjusters: Get valuable advice on effective questioning and listening skills.
- Building Relationships: Gain insights on fostering relationships through shared experiences.
Tune in to gain practical tips and insights that can help shape a positive and effective claims process!
Season 9 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Matt Yehling, Directory of Claims at Midwest Employers Casualty.
Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkindcomp.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
Hello everybody and welcome to Adjusted.
I'm your host, greg Hamblin,coming at you from beautiful
Birmingham, alabama, and I'mexcited to share with you this
rebroadcast.
This one is actuallyparticularly important to me.
I've had the opportunity towork with Carol Beerwagon for
(00:31):
almost two decades.
I think I started one yearbefore her and we were on the
same team, so our careers havesort of followed each other
along, taking different paths,but she's truly an expert in her
field and in this episode wehad the opportunity to dive deep
on the investigation side andreally talk about how do we
investigate a claim so that wecan get the best outcome and we
(00:53):
have all the information to makethe right decision.
So I hope you enjoy this one asmuch as I did and just want to
remind everybody to like, followand share the podcast.
Certainly, if you have time, wewould love it if you leave us a
five-star and leave a review sothat others can find their way
here and with that I'll remindfolks to do right, think
(01:16):
differently and don't forget tocare and enjoy.
Hello everybody and welcome toAdjusted.
I'm your host, greg Hamlin,coming at you from beautiful
Birmingham, alabama, where theweather is wonderful in December
.
We are in the 70s, 60s and 70s,so I'm not complaining about
that.
Having grown up in the Midwest,I was up there for the holidays
(01:37):
and it was negative 30 withwindchill, so I'm glad to be
back in the South where it'swarm.
With me is my co-host today,matt Yaling.
Matt, I'll go ahead and let youintroduce yourself.
Speaker 2 (01:49):
Hello, this is Matt Yaling, and I'm joining you from
St Louis, missouri, along thebanks of the mighty Mississippi,
and we're having some prettygood weather up here too today.
So happy new year, everyone,and looking forward to 2023.
Speaker 1 (02:01):
Absolutely Happy new year.
We have a special guest with ustoday, carol Beerwagon.
She is a Senior CatastrophicResolution Specialist for
Berkeley Industrial Comp, so Ihave the pleasure of working
with her regularly, so wanted togo ahead and let her say hello
to everybody.
Speaker 3 (02:19):
Hi everybody, Thanks for having me on.
I'm excited to be here.
Speaker 1 (02:23):
Yeah, Carol and I actually started within maybe a
year or two of each other andwe're trained by the same person
.
So if she's listening, I willsay a shout out to Andrea Stott.
She did a good job with both ofus.
So we're still here all theseyears later.
So that's kind of how our pathscrossed years ago.
But maybe just to give us alittle bit more of your
(02:45):
background, Carol, I'm sure thatyou always knew you were going
to be in workers' compensation,right?
Speaker 3 (02:52):
Not exactly something you dream of from kindergarten,
but it worked out.
No, I started at IndianaUniversity for college and
thought I wanted to be a fashionbuyer and live in New York City
.
Changed my mind, decided Iwanted to stay a fashion buyer
and live in New York City.
Changed my mind, decided Iwanted to stay here in the
Midwest and there's not a lot offashion buying opportunities
here.
So I thought I would go intoretail management, did an
(03:15):
internship and realized that wasnot for me.
So I went to a job fair justtrying to find something that
would pay me and that was closeto home towards the end of my
senior year and just kind offell into my prior employer and
at that point in time I didn'tknow what workers' comp
insurance was, and so theyreally trained me from the
(03:35):
ground up.
So I worked there for about 16years before coming here to
Berkeley in September of 21.
Speaker 1 (03:42):
That's awesome.
Well, I know the world will beshocked that Indianapolis is not
the new Paris, but you neverknow.
Right Things could change.
But I remember when you startedI was like apparel
merchandising degree.
That's interesting.
I haven't seen that go intoclaims.
Speaker 3 (03:57):
It was a good business background and some
marketing in there too, so itwas a good general business
degree, but definitely not whereI saw myself when I started
school.
Speaker 2 (04:07):
That's awesome.
So how do we segue into?
What types of claims do youwork with in the workers' comp
industry from the apparelmerchandising background?
Speaker 3 (04:17):
Not too many fashion claims unfortunately Falling off
the runway and that kind ofthing, yeah but the claims I'm
handling now are mostly seriousloss and catastrophic claims and
I really enjoy that type ofwork.
I kind of eased into it justlearning to handle some of the
more complicated injuries andmore complicated legal claims
(04:38):
and really enjoyed those.
Those were my favorite to workon.
So I've been learning a lot.
There's never a dull day.
Speaker 2 (04:46):
So when you say serious loss and catastrophic
claims, maybe break that down alittle further.
What's that entail?
What kind of claims are youseeing?
Are these auto accidents orslip and falls, or a little bit
of both?
Or what's the generalday-to-day breakdown of those
look like for you?
Speaker 3 (05:02):
Yeah, it's a little bit of everything.
So we do have some miningclaims that we see some serious
injuries with A lot of tools,the industrial tools that
they're using.
Sometimes they're tools thathave malfunctioned, but more
often than not it's tools beingused in a way they shouldn't be
used or safety mechanisms beingdisabled and injuring folks saws
(05:26):
, falls from great heights,motor vehicle accidents,
chemical inhalation, those kindsof things.
Speaker 1 (05:32):
Yeah, there are definitely no dull days on our
CAT team and for those who don'tknow, Berkeley Industrial Comp,
we specialize in high hazardworkers' compensation insurance,
so we don't have a whole lot offrequency.
We don't see a whole lot ofsmall little claims, but when we
do see injuries they're prettychallenging because of the types
of businesses that we insure.
(05:52):
So great questions.
Matt, I'm glad that you askedthat.
Our topic for today is claimsinvestigation.
So I wanted to bring Carol onto talk about this because she's
been doing this for a while andit's a big part of claims is
making sure we understandexactly what happened, how it
happened, to who it happened andmaking sure we know what we're
(06:13):
covering.
And so I wanted to maybe startbefore we get too deep into
claims investigation.
And just I'm going to throw aword out there that may not be
familiar to everybody who's notin the workers' compensation
space, but would be for maybe anadjuster, and that's the word
compensability.
So obviously a lot starts atcoverage and compensability,
(06:35):
which are the beginnings of anyclaims investigation.
Carol, do you want to talk alittle bit about compensability?
Speaker 3 (06:41):
Yeah, so the high level definition of it is if a
injured worker is in the courseand scope of their employment at
the time of the injury, and sowhat that means in English is
were they at work and workingwhen the injury occurred, and
was the injury work related?
(07:03):
And so, in order to determinethose things, you have a lot of
questions to ask, and that's whywe need to investigate the
claim.
Speaker 2 (07:12):
Yeah, so you mentioned this earlier about the
types of accidents you'reseeing.
Sometimes there's machinery orequipment or they're working
from heights and other things.
So maybe a leading questionhere.
But why is that investigationso important to you know, to
confirm compensability and tokind of outline the claim?
Speaker 3 (07:34):
Well, like all of our lives, they're complicated, and
so just because somebody fallsat work, just a fall in and of
itself, that's not enoughinformation.
Where were they when they fell?
What were they doing?
Were they working at the time?
Were there drugs or alcoholinvolved?
How high up were they?
Did they have safety gear on?
(07:55):
Did the safety gear malfunction?
All of those answers can reallyplay into whether or not a
claim is compensable and beyondcompensability.
It also helps us understand howthe injury occurred, which is
important to understand theinjuries themselves, and then it
also helps us to identifypotential safety issues with
(08:18):
that insured.
Maybe it's a fluke or maybeit's something that needs to be
addressed so that future seriousinjuries don't occur.
Speaker 1 (08:26):
And that's an excellent point.
One that sometimes we forgetabout is just how important it
is to make sure that we'relooking at this through the lens
of the future too, because thenext injury we could avoid from
learning from how this happenedespecially with our insurance
that are doing some prettydifficult tasks.
You know, something as simpleas making sure people have the
right safety equipment at theright time and the right
(08:49):
training could avoid somethingthat could happen in the future.
So I think those are reallygood points.
One of the things that happensin the industry is we take
statements of our injury workers, hopefully towards the
beginning of the claim, when allthe information is fresh.
But, Carol, can you talk alittle bit about the importance
of statements and what'simportant when a adjuster's
(09:10):
taking a statement?
Speaker 3 (09:12):
Yeah, so I think a recorded statement's important
because it memorializes theconversation.
That way the adjuster can referback to it later if their notes
don't reflect somethingspecific that was discussed.
Or it may be that thatstatement is needed down the
road in litigation if theinjured worker makes statements
(09:32):
contradictory to what was saidduring the recording.
So it's important that we havethat conversation memorialized.
Speaker 1 (09:40):
So, in that, as you think about a statement, taking
a recorded statement, what aresome of the important things to
cover?
What are some of the thingsthat you want to cover when you
take a statement?
Speaker 3 (10:08):
happened?
What specific body parts areinvolved?
If somebody hurts their back,that can go up the back into the
shoulders and the neck, it cango down into the hips and the
legs and we can view thatsometimes as what we call body
creep, where these injuries keepmoving.
But sometimes it's also that,hey, when I fell and hurt my
back, I also hurt my knee, but Ididn't really tell you about my
knee at the beginning becausemy back hurt worse.
So it's really important thatwe ask specific questions to
(10:32):
understand the full extent oftheir injuries and then again
understanding the circumstancesaround the injury.
So sometimes we can identifyspecific defenses or issues with
compensability during thestatement.
For example, if someone mighthave been on medication that
(10:53):
they shouldn't have been workingon, that can be a potential
drug violation.
You know, that might besomething we need to look into a
little bit further.
Speaker 2 (11:01):
So I mean, when we talk about investigation we've
been talking a lot about, youknow, the injured employee, but
the investigation is not just,you know, that single person
right, sometimes there'switnesses, and so you know what
other levels of investigationand who else are you talking to
during your investigation period.
Speaker 3 (11:19):
Yeah, so there's lots of other folks that we need to
talk to outside of the injuredworker.
I would say our ramp team isreally important when
investigating because I don'talways understand the job
industry that this person isworking in or understand the
names of the tools or the termsthat are used.
(11:40):
I can Google it but that doesn'talways answer my question and
our ramp risk management team isreally great at being able to
explain that further and explainif a injured worker statement
or a mechanism of injury makessense or if there's more
questions that need to be askedthat I would not otherwise know
about.
(12:00):
And then I think also defensecounsel has been a really great
resource for me as well.
Even before I think alsodefense counsel has been a
really great resource for me aswell.
Even before I make anyinvestigative phone calls to
understand the jurisdiction, youcan read an accident summary
and some basic information offof a first report of injury and
already develop some questionsand wonder well, is this
(12:22):
compensable in this state?
What are the specific rulesaround that type of injury or
circumstance in thisjurisdiction?
And so sometimes I pick up thephone and call defense counsel
and ask those questions before Ieven contact the employer or
the injured worker.
That way I can develop a listof my own questions to ask when
(12:45):
I'm having those conversationswith the employer or injured
worker.
Speaker 2 (12:49):
Sometimes my kids read Amelia Bedelia and
sometimes we take things soliterally and it's like you
talked about bringing in theramp team and not understanding
the industry and not being aspecialist and everything.
It's like sometimes it's goodto know somebody that's involved
in trucking.
So you're talking about, youknow, a reefer truck and you're
like what the heck is a reefertruck?
And it's like, oh, it's arefrigerated truck.
(13:10):
So, like you know, when we'reseeing these first reports of
injury, it's, you know, somebodywas climbing on top of the
reefer truck and I'm thinkingCheech and Chong driving down
the highway and I'm like whatthe hell does that mean and then
like no, that's a refrigeratedtruck.
I was like, oh okay, well, whydidn't you just say that?
Like well, we refer to thesethings differently so we all
have our own kind of terminologyand stuff.
(13:32):
So when those injury reportscome in, you know you start to
my head jumps to like probablythe worst possible thing and
sometimes it's, you know, easilyexplainable.
And yeah, that Amelia Bedeliamentality of thinking of things
very literally.
Sometimes you need theclarification.
Speaker 3 (13:48):
Absolutely, and I think witnesses are a big part
of that investigation as well,because they offer another
perspective of the injury, andwhen I say perspective, I mean
that in several ways, bothvisually, because they saw the
accident occur from anotherangle.
They might've seen thesurroundings of the injured
(14:09):
worker that the injured workerthemselves did not see.
But they can also help,corroborate or impeach the
injured worker or otherwitnesses.
In fact, I had a claim recentlywhere one witness supported
what the injured worker said andthen two others completely
contradicted those stories.
So it's really important tospeak not only to a witness but
(14:32):
to all of the witnesses.
Speaker 1 (14:35):
And that's an excellent point.
Sometimes when we get in thecheck the box mentality, where
we talk to the injured worker wesay okay, there's a witness,
and we talk to the witness andwe move on without really
thinking about the whole picture, we can get ourselves in a
little bit of trouble and missout on all the information of
what exactly happened.
So I'm glad that you pointedthat out.
(14:56):
One of the other things thatyou talked about there that I
thought was interesting youtalked a little bit about first
reports of injury and I thinkboth Matt and you hit on
something that sometimes what'son there either we don't
understand it or it might notalways be accurate.
I know we've seen times wherewe've had a claim reported as a
medical only claim, only to findout that it's much more severe.
(15:16):
I can think of one that we had,that said, a head laceration,
and we found out later that hehad had a grinder go through his
forehead, which is a lotdifferent than a head laceration
, obviously.
So we're talking about a veryserious traumatic brain injury.
Luckily the injured worker didrecover from that, but we didn't
know about it initially becauseit had been classified wrong.
(15:37):
Carol, can you talk a littlebit about first reports of
injury and the importance ofkind of confirming with the
employer what actually happened.
Speaker 3 (15:45):
Yeah, I think a first report of injury is sort of my
first line of investigation.
So as soon as I get a new claimcoming in whether it's new or
even if it's a few weeks ormonths old I always start with
the first report of injury.
Not only does it give you asummary of what happened, but it
also says who reported theclaim and it gives you an idea
of where the employer is located, where the accident occurred
(16:08):
and where the injured workerlives.
That's important becausesometimes those aren't always in
the same city or even state.
So if you've got an injuredworker who's seriously injured
in Ohio but they live in Texas,you've got some work ahead of
you to try and get them home forrecovery where they have
familial support and where theycan be with their belongings and
(16:33):
have to move doctors from wheretheir original injury was to
their home state.
So those are all importantthings to know.
Going into a claim.
It's also helpful to confirmthat you're in the right
jurisdiction to be sure that theclaim was reported correctly,
and that's certainly importantbecause every state has
(16:54):
different laws.
You want to be sure you'rehandling the claim in the
correct jurisdiction andfollowing the correct laws.
And sometimes those firstreports of injury also identify
the people you need to talk to,obviously not only the injured
worker, but the person whoreported the claim.
You certainly want to speak tothem, and sometimes they also
list the witnesses and theinitial medical provider.
(17:17):
So that's all really importantinformation and kind of your
first step on the investigationjourney.
Speaker 2 (17:23):
So where does empathy fit into the claims
investigation versus ajust-the-facts-ma'am approach to
investigation?
Speaker 3 (17:32):
I think the point of the investigation is certainly
not to drill the injured worker.
So sometimes we can get intothe habit of going through just
the questions that we'vedeveloped or perhaps that are
even on a recorded statement.
Instead of just going throughbasic questions, we want to
listen to the individual.
(17:52):
There's multiple reasons forthat One.
They're a human being and theydeserve to be listened to, and
that is a way of showing empathynot just waiting for them to be
done talking and moving on tothe next question, but genuinely
listening and hearing what theyhave to say, hearing what their
concerns are.
Sometimes there's follow-upquestions that need to be asked,
(18:14):
and so that's important as well.
But again, the point of aninvestigation is not to drill
someone.
We're meeting these people atsome of the lowest points in
their lives.
They're hurt, they're scared,they don't know how they're
going to provide for theirfamily, and it's our first
chance to not only investigatethe claim but to explain the
(18:36):
workers' comp process and builda relationship and a rapport
with them and tell them whatwe're going to do to try and
help them get better and providefor their family in this scary
time.
Speaker 1 (18:47):
I think you really hit on some really important
concepts there, and I think,unfortunately, there's a thought
process that insurancecompanies are looking for ways
to deny claims and ruin people'slives, and that's just, you
know.
Obviously, our goal is to dothe right thing and we want to
do the right thing for everybodyinvolved, and it is a balancing
act because we have a policyholder that's paying us a
premium, we have an injuredworker who's hurt.
(19:08):
There's a lot that we're tryingto do when we say do the right
thing.
And empathy, in my opinion, iswhere it starts.
Obviously, you know, I think ofour injured workers a lot, like
I do my children.
I know people say I have, youknow, I talk a lot about how I
have six kids, but you know, Itrust my children to a point,
because I remember I was a kidonce too, and I was a pretty
(19:30):
good kid, but my parents didn'tknow everything I did, you know.
So we hope that our injuredworkers are always coming at
this with the right attitude andthe right thoughts.
But you know, we do have tomake sure that all the facts
line up and that what we have isa compensable claim before we
start paying for something thatmaybe isn't, and we've seen some
examples of that.
(19:50):
Unfortunately, they're theminority, but they do exist.
So, when you are taking astatement, why is it important
on our end to keep our ownjudgments and assumptions in
check?
Because obviously we all haveour own biases.
Speaker 3 (20:04):
Wow.
Well, I think, first of all,it's just a good life skill to
develop.
We want to treat everybody aswe want to be treated and not be
judged or have assumptions madeabout us.
But I think specific toinvestigating a claim if we
assume, we're usually going tobe wrong and if we don't ask, we
(20:25):
don't know.
So in order to investigatethoroughly, we need to know what
we don't know and then we canask the questions.
And again, so much of thatstarts with follow-up questions
and listening to the injuredworker, not just moving on to
the next question.
If we just hear the basicinformation that they're willing
(20:47):
to share right off the bat andnot dig in and ask further
questions, there's going to be alot of information later down
the road that you realize youdon't know and then it's harder
to go back and ask that persondetails later.
For lots of reasons, Memoriesfade, attorneys get involved,
(21:08):
and if we can ask the questionright at the beginning, then we
have a very clear understandingof the facts.
And that goes for investigatinga claim with compensability,
but also things like hey, what'syour house like?
Do you have a lot of stairs?
Is your bedroom on the firstfloor?
If someone's severely injuredand they're going to end up
(21:31):
going home after some time inrehab, we need to know what kind
of modifications might beneeded for their home or what
sort of equipment they mightneed to serve them best while
they're at home.
And it's a lot easier if youknow all that information up
front than trying to chasesomebody down to get that
information later.
Speaker 2 (21:49):
Yeah, if there's family, friends who lives with
them, all that good stuff thatyou're going to be asking.
So, there's generally a lotgoing on during that initial few
days of the investigation.
What are some of the otherdocuments that you like to
obtain and review during yourinitial investigation of a claim
?
Speaker 3 (22:06):
Yeah.
So again, the first report ofinjury is where I start and then
I usually go to an index report.
So I'm looking to see if theyhave prior injuries that pertain
to this claim.
Are they litigious?
Can I expect an attorney onthis claim?
And when I'm looking at priorinjuries, I'm not just looking
at oh, this is a shoulder claim.
(22:26):
Have they had a shoulder injurybefore?
We all know that body parts areconnected, so a prior head
injury or neck injury might berelevant to this shoulder claim,
because we all know that a lotof neck pain can go into
shoulder and vice versa.
I'm also looking at the policyto confirm coverage.
(22:46):
I'm looking at medical recordsto confirm that the mechanism of
injury matches what I know tobe true, what their medical
history is and whether or notthat might impact recovery and
healing.
Somebody who's a diabetic and apack a day smoker and has a
injury.
That's not a good thing and Ineed to be aware that their
(23:09):
healing is going to take alittle bit longer.
And then again I'm looking atwitness statements that maybe
have already been taken by theemployer.
Sometimes there's writtenstatements from witnesses when
insureds can provide their owninvestigative reports that
they've done.
That's super helpful.
It's again another take on whathappened to cause the injury.
(23:31):
If there's photos, those arereally helpful.
Instead of imagining thescenario, I can physically see
it videos of the injury or evenjust of the job that the person
was doing.
So, for example, I had adriller who had a drill come
down a very large drill, miningdrill come down on his foot.
(23:52):
I didn't understand what hewould have been doing at the
time and how this injuryoccurred.
The employer was able to sendme kind of a series of photos
explaining the job that he wasdoing and that way I was really
able to piece together whathappened to cause the injury.
So those things are all reallyimportant to have.
Speaker 1 (24:12):
One of the things you were mentioning.
You know getting videos orphotos from the insured One of
the things that's been morecommon that I've seen and I'm
wondering if you've seen this asdash cams or surveillance video
, like at a gas station orsomewhere else.
You know that that has, likeyou know, security video footage
and police cams now are a newthing that we're starting to see
(24:34):
more of.
So have you seen any of thosethings play into your
investigation?
Speaker 3 (24:38):
Yeah, I've had a couple instances where the
insured's closed circuit TVsystem has really helped.
It's shown the injury or hasshown aftermath.
I suppose you would say we canconfirm timing, we can confirm
who was there.
Sometimes we can see the injuryitself happen.
If a third party is involved,we have evidence or proof of
(24:58):
that.
In terms of subrogation, that'sbeen really helpful.
The black boxes in vehiclesmost modern vehicles now have
their own version of a black box, so that can be really helpful,
especially with motor vehicleaccidents, to determine how fast
the vehicle was going whensomeone started braking, the
(25:19):
timing of impact.
Those sorts of things have beenreally helpful to have as well.
Speaker 2 (25:24):
Sharon, I think you hit on a word that I don't know
if we've had this topic onsubrogation and maybe we have,
but that's a pretty big thingfor an insurance company.
Workers' comp is no fault.
But if there's another partythat you mentioned like flips
from heights or falls, safetyequipment where it's either you
know it's failed or somethingelse has failed, or a motor
(25:46):
vehicle accident, all those kindof raise another level of
investigation right aroundsubrogation.
And is there another party atfault?
Is there another potentialrecovery available for both the
injured employee and, you know,the insurance carrier
potentially?
So I mean, I think that's a bigpart of that in this
investigative piece that youknow we could probably spend a
whole nother podcast justtalking about subrogation in
(26:06):
general.
So you know.
So there's lots of things youknow, I know from being on the
front lines and doing thoseinvestigations.
You know there's you startopening up, you know, what could
seem like a Pandora's box ofinvestigation on some of these
claims, the more complicatedthey are.
So what's an important you know, and you mentioned mechanism of
injury earlier too.
So why is that important foryou to use and what's you know,
(26:29):
what's that going to helpexplain, you know, for you
during the investigation of theclaim.
Speaker 3 (26:34):
I think the mechanism of injury is important for
several reasons.
It's going to again help usdetermine that the injured
worker was doing their job, wasworking at the time of the
injury.
It's going to help us identifyfuture safety issues.
You know, if the job thatthey're doing is unsafe and
that's what caused the injury,then how can we make it safer in
(26:58):
the future?
That's something that our rampteam and our underwriting team
both need to be aware of.
If safety issues like that areidentified, specifically ones
that we've seen before over andover with the same insured, I
think making sure that themechanism of injury and the
diagnosis itself makes sense isimportant.
(27:19):
I have no medical background,no medical degrees, but just
common sense comes into place orplay Sometimes, you know being
sure hey, if something fell andlanded on my left foot, then why
does my shoulder hurt?
You know things like that.
Speaker 2 (27:36):
Yeah, I mean, I think there's a lot of truth to that.
How do you improve something sothat you know we can prevent
this injury from occurring?
How do we ensure that we'reputting our injured employees in
the best possible position toboth be successful for whatever
organization they're working for, and to return back home every
night for their families?
So I think that investigationis an important piece of how do
(27:57):
we improve the process to avoidthis ever happening again and
ensure they're preparing for anappropriate loss.
I know Greg has a final questionfor you too.
Speaker 1 (28:07):
Yeah, well, I actually just had a couple of
thoughts I wanted to pick yourbrain on as we wrap things up,
but one of them was so havingdone this, carol for coming up,
I don't think you're gettingclose to 20 years now doing this
.
If you could go back and tellCarol in year one don't forget
to do this part, because I'velearned a lot in that time what
would be the thing that youwould say, hey, you know.
(28:28):
Going back and telling you 20years ago, what would you tell
yourself, don't you know?
This is the part you need tonot forget about it.
On a claims investigation.
Speaker 3 (28:37):
I think there would be two main things I would tell
myself.
The first would be, again, notto stick to that recorded
interview script.
I think initially, whenworkers' comp adjusters are new
at investigating, we can getnervous and hyped up about
wanting to develop a rapportwith someone.
(28:57):
But also be sure we thoroughlyinvestigate and we get
overwhelmed easily on the phone,especially if a conversation
goes in a direction that maybewe didn't expect it to go.
So, really having sort of a listof questions typed up or
written out on a note that Iwant to be sure and ask it's not
(29:19):
necessarily what's on arecorded statement script, like
I need your address and date ofbirth and those sorts of things
those become common sense to askor to verify.
But to really get to the heartof that specific person's injury
and not use generic questionsand listening to their answers
and asking follow-up questions.
(29:39):
That would be the first, andthe second I think it ties in
with it is to be empatheticbecause again, as a new adjuster
, you're so concerned aboutbeing sure that you get all the
questions answered that you canget into this robotic like tone
almost, and you forget thatthese, this person, has a life
(30:02):
when they hang up the phone withyou and they have questions and
they're scared, and so if youcan make them feel better by
providing answers to theirquestions and giving your
contact information really basicstuff that seems like common
sense, but sometimes us newadjusters are so busy that we
just got to get our questionsanswered and get off the phone
(30:23):
so we can move on, and that'sreally harmful to both parties
when we do that.
Speaker 1 (30:33):
I'll tell you what, carol.
I'm so glad that I had you onthis episode, because the things
you highlighted, I just thinkare missing in a lot of people
in this industry, so I'm gladthat you pointed that out the
curiosity, asking questions,good questions and really trying
to understand.
And then, I think, the otherpiece of being sure that we show
empathy and that we don'tforget that they're going
through something difficult,regardless of what our job is,
(30:53):
to make sure that we do thosethings is something that the
whole industry could learn alittle bit from you on.
So thank you for highlightingthat.
You know, one of the things Iwanted to highlight this year,
as we move into 2023, is Iwanted to ask each of our guests
something that they're gratefulfor.
I feel like we live in a worldwhere there is very me-centered
(31:16):
culture, and so I'm going to tryto, this season, put some,
again, good vibes out in theuniverse, and my thought is just
to ask people what are yougrateful for?
Speaker 3 (31:24):
I'm grateful for my family.
I have a fantastic husband andtwo really great daughters, 10
and 13.
And then I have extended familyclose by that we have great
relationships with and that areable to help when we need it.
And I'm grateful for my job ascorny as that sounds, I work to
(31:46):
live, not live to work.
And my job allows me to keep mymind busy and be intrigued and
to learn, but most importantly,it helps me to continue doing
what I love doing, which isbeing with my family and
enjoying my time and providingfor them.
Speaker 1 (32:04):
Well, I absolutely love that, Carol.
I think that's obviously a lotof the reasons why we do what we
do and really appreciate havingyou as a guest today.
And we'll just remind folks ourtheme to do right, think
differently and don't forget tocare.
And with that we will wrap upthis episode and hope you'll
follow us in future episodesreleasing every two weeks on
(32:25):
Monday.
You can also catch our blog onthe off weeks that is written by
our wonderful Natalie Dangles.
So again, remind everybody todo right, think differently and
don't forget to care.
And that's it, guys.
Thank you.
Hello everybody and welcome to Adjusted.
I'm your host, greg Hamblin,coming at you from beautiful
Birmingham, alabama, and I'mexcited to share with you this
rebroadcast.
This one is actuallyparticularly important to me.
I've had the opportunity towork with Carol Beerwagon for
(00:31):
almost two decades.
I think I started one yearbefore her and we were on the
same team, so our careers havesort of followed each other
along, taking different paths,but she's truly an expert in her
field and in this episode wehad the opportunity to dive deep
on the investigation side andreally talk about how do we
investigate a claim so that wecan get the best outcome and we
(00:53):
have all the information to makethe right decision.
So I hope you enjoy this one asmuch as I did and just want to
remind everybody to like, followand share the podcast.
Certainly, if you have time, wewould love it if you leave us a
five-star and leave a review sothat others can find their way
here and with that I'll remindfolks to do right, think
(01:16):
differently and don't forget tocare and enjoy.
Hello everybody and welcome toAdjusted.
I'm your host, greg Hamlin,coming at you from beautiful
Birmingham, alabama, where theweather is wonderful in December
.
We are in the 70s, 60s and 70s,so I'm not complaining about
that.
Having grown up in the Midwest,I was up there for the holidays
(01:37):
and it was negative 30 withwindchill, so I'm glad to be
back in the South where it'swarm.
With me is my co-host today,matt Yaling.
Matt, I'll go ahead and let youintroduce yourself.
Speaker 2 (01:49):
Hello, this is Matt Yaling, and I'm joining you from
St Louis, missouri, along thebanks of the mighty Mississippi,
and we're having some prettygood weather up here too today.
So happy new year, everyone,and looking forward to 2023.
Speaker 1 (02:01):
Absolutely Happy new year.
We have a special guest with ustoday, carol Beerwagon.
She is a Senior CatastrophicResolution Specialist for
Berkeley Industrial Comp, so Ihave the pleasure of working
with her regularly, so wanted togo ahead and let her say hello
to everybody.
Speaker 3 (02:19):
Hi everybody, Thanks for having me on.
I'm excited to be here.
Speaker 1 (02:23):
Yeah, Carol and I actually started within maybe a
year or two of each other andwe're trained by the same person
.
So if she's listening, I willsay a shout out to Andrea Stott.
She did a good job with both ofus.
So we're still here all theseyears later.
So that's kind of how our pathscrossed years ago.
But maybe just to give us alittle bit more of your
(02:45):
background, Carol, I'm sure thatyou always knew you were going
to be in workers' compensation,right?
Speaker 3 (02:52):
Not exactly something you dream of from kindergarten,
but it worked out.
No, I started at IndianaUniversity for college and
thought I wanted to be a fashionbuyer and live in New York City
.
Changed my mind, decided Iwanted to stay a fashion buyer
and live in New York City.
Changed my mind, decided Iwanted to stay here in the
Midwest and there's not a lot offashion buying opportunities
here.
So I thought I would go intoretail management, did an
(03:15):
internship and realized that wasnot for me.
So I went to a job fair justtrying to find something that
would pay me and that was closeto home towards the end of my
senior year and just kind offell into my prior employer and
at that point in time I didn'tknow what workers' comp
insurance was, and so theyreally trained me from the
(03:35):
ground up.
So I worked there for about 16years before coming here to
Berkeley in September of 21.
Speaker 1 (03:42):
That's awesome.
Well, I know the world will beshocked that Indianapolis is not
the new Paris, but you neverknow.
Right Things could change.
But I remember when you startedI was like apparel
merchandising degree.
That's interesting.
I haven't seen that go intoclaims.
Speaker 3 (03:57):
It was a good business background and some
marketing in there too, so itwas a good general business
degree, but definitely not whereI saw myself when I started
school.
Speaker 2 (04:07):
That's awesome.
So how do we segue into?
What types of claims do youwork with in the workers' comp
industry from the apparelmerchandising background?
Speaker 3 (04:17):
Not too many fashion claims unfortunately Falling off
the runway and that kind ofthing, yeah but the claims I'm
handling now are mostly seriousloss and catastrophic claims and
I really enjoy that type ofwork.
I kind of eased into it justlearning to handle some of the
more complicated injuries andmore complicated legal claims
(04:38):
and really enjoyed those.
Those were my favorite to workon.
So I've been learning a lot.
There's never a dull day.
Speaker 2 (04:46):
So when you say serious loss and catastrophic
claims, maybe break that down alittle further.
What's that entail?
What kind of claims are youseeing?
Are these auto accidents orslip and falls, or a little bit
of both?
Or what's the generalday-to-day breakdown of those
look like for you?
Speaker 3 (05:02):
Yeah, it's a little bit of everything.
So we do have some miningclaims that we see some serious
injuries with A lot of tools,the industrial tools that
they're using.
Sometimes they're tools thathave malfunctioned, but more
often than not it's tools beingused in a way they shouldn't be
used or safety mechanisms beingdisabled and injuring folks saws
(05:26):
, falls from great heights,motor vehicle accidents,
chemical inhalation, those kindsof things.
Speaker 1 (05:32):
Yeah, there are definitely no dull days on our
CAT team and for those who don'tknow, Berkeley Industrial Comp,
we specialize in high hazardworkers' compensation insurance,
so we don't have a whole lot offrequency.
We don't see a whole lot ofsmall little claims, but when we
do see injuries they're prettychallenging because of the types
of businesses that we insure.
(05:52):
So great questions.
Matt, I'm glad that you askedthat.
Our topic for today is claimsinvestigation.
So I wanted to bring Carol onto talk about this because she's
been doing this for a while andit's a big part of claims is
making sure we understandexactly what happened, how it
happened, to who it happened andmaking sure we know what we're
(06:13):
covering.
And so I wanted to maybe startbefore we get too deep into
claims investigation.
And just I'm going to throw aword out there that may not be
familiar to everybody who's notin the workers' compensation
space, but would be for maybe anadjuster, and that's the word
compensability.
So obviously a lot starts atcoverage and compensability,
(06:35):
which are the beginnings of anyclaims investigation.
Carol, do you want to talk alittle bit about compensability?
Speaker 3 (06:41):
Yeah, so the high level definition of it is if a
injured worker is in the courseand scope of their employment at
the time of the injury, and sowhat that means in English is
were they at work and workingwhen the injury occurred, and
was the injury work related?
(07:03):
And so, in order to determinethose things, you have a lot of
questions to ask, and that's whywe need to investigate the
claim.
Speaker 2 (07:12):
Yeah, so you mentioned this earlier about the
types of accidents you'reseeing.
Sometimes there's machinery orequipment or they're working
from heights and other things.
So maybe a leading questionhere.
But why is that investigationso important to you know, to
confirm compensability and tokind of outline the claim?
Speaker 3 (07:34):
Well, like all of our lives, they're complicated, and
so just because somebody fallsat work, just a fall in and of
itself, that's not enoughinformation.
Where were they when they fell?
What were they doing?
Were they working at the time?
Were there drugs or alcoholinvolved?
How high up were they?
Did they have safety gear on?
(07:55):
Did the safety gear malfunction?
All of those answers can reallyplay into whether or not a
claim is compensable and beyondcompensability.
It also helps us understand howthe injury occurred, which is
important to understand theinjuries themselves, and then it
also helps us to identifypotential safety issues with
(08:18):
that insured.
Maybe it's a fluke or maybeit's something that needs to be
addressed so that future seriousinjuries don't occur.
Speaker 1 (08:26):
And that's an excellent point.
One that sometimes we forgetabout is just how important it
is to make sure that we'relooking at this through the lens
of the future too, because thenext injury we could avoid from
learning from how this happenedespecially with our insurance
that are doing some prettydifficult tasks.
You know, something as simpleas making sure people have the
right safety equipment at theright time and the right
(08:49):
training could avoid somethingthat could happen in the future.
So I think those are reallygood points.
One of the things that happensin the industry is we take
statements of our injury workers, hopefully towards the
beginning of the claim, when allthe information is fresh.
But, Carol, can you talk alittle bit about the importance
of statements and what'simportant when a adjuster's
(09:10):
taking a statement?
Speaker 3 (09:12):
Yeah, so I think a recorded statement's important
because it memorializes theconversation.
That way the adjuster can referback to it later if their notes
don't reflect somethingspecific that was discussed.
Or it may be that thatstatement is needed down the
road in litigation if theinjured worker makes statements
(09:32):
contradictory to what was saidduring the recording.
So it's important that we havethat conversation memorialized.
Speaker 1 (09:40):
So, in that, as you think about a statement, taking
a recorded statement, what aresome of the important things to
cover?
What are some of the thingsthat you want to cover when you
take a statement?
Speaker 3 (10:08):
happened?
What specific body parts areinvolved?
If somebody hurts their back,that can go up the back into the
shoulders and the neck, it cango down into the hips and the
legs and we can view thatsometimes as what we call body
creep, where these injuries keepmoving.
But sometimes it's also that,hey, when I fell and hurt my
back, I also hurt my knee, but Ididn't really tell you about my
knee at the beginning becausemy back hurt worse.
So it's really important thatwe ask specific questions to
(10:32):
understand the full extent oftheir injuries and then again
understanding the circumstancesaround the injury.
So sometimes we can identifyspecific defenses or issues with
compensability during thestatement.
For example, if someone mighthave been on medication that
(10:53):
they shouldn't have been workingon, that can be a potential
drug violation.
You know, that might besomething we need to look into a
little bit further.
Speaker 2 (11:01):
So I mean, when we talk about investigation we've
been talking a lot about, youknow, the injured employee, but
the investigation is not just,you know, that single person
right, sometimes there'switnesses, and so you know what
other levels of investigationand who else are you talking to
during your investigation period.
Speaker 3 (11:19):
Yeah, so there's lots of other folks that we need to
talk to outside of the injuredworker.
I would say our ramp team isreally important when
investigating because I don'talways understand the job
industry that this person isworking in or understand the
names of the tools or the termsthat are used.
(11:40):
I can Google it but that doesn'talways answer my question and
our ramp risk management team isreally great at being able to
explain that further and explainif a injured worker statement
or a mechanism of injury makessense or if there's more
questions that need to be askedthat I would not otherwise know
about.
(12:00):
And then I think also defensecounsel has been a really great
resource for me as well.
Even before I think alsodefense counsel has been a
really great resource for me aswell.
Even before I make anyinvestigative phone calls to
understand the jurisdiction, youcan read an accident summary
and some basic information offof a first report of injury and
already develop some questionsand wonder well, is this
(12:22):
compensable in this state?
What are the specific rulesaround that type of injury or
circumstance in thisjurisdiction?
And so sometimes I pick up thephone and call defense counsel
and ask those questions before Ieven contact the employer or
the injured worker.
That way I can develop a listof my own questions to ask when
(12:45):
I'm having those conversationswith the employer or injured
worker.
Speaker 2 (12:49):
Sometimes my kids read Amelia Bedelia and
sometimes we take things soliterally and it's like you
talked about bringing in theramp team and not understanding
the industry and not being aspecialist and everything.
It's like sometimes it's goodto know somebody that's involved
in trucking.
So you're talking about, youknow, a reefer truck and you're
like what the heck is a reefertruck?
And it's like, oh, it's arefrigerated truck.
(13:10):
So, like you know, when we'reseeing these first reports of
injury, it's, you know, somebodywas climbing on top of the
reefer truck and I'm thinkingCheech and Chong driving down
the highway and I'm like whatthe hell does that mean and then
like no, that's a refrigeratedtruck.
I was like, oh okay, well, whydidn't you just say that?
Like well, we refer to thesethings differently so we all
have our own kind of terminologyand stuff.
(13:32):
So when those injury reportscome in, you know you start to
my head jumps to like probablythe worst possible thing and
sometimes it's, you know, easilyexplainable.
And yeah, that Amelia Bedeliamentality of thinking of things
very literally.
Sometimes you need theclarification.
Speaker 3 (13:48):
Absolutely, and I think witnesses are a big part
of that investigation as well,because they offer another
perspective of the injury, andwhen I say perspective, I mean
that in several ways, bothvisually, because they saw the
accident occur from anotherangle.
They might've seen thesurroundings of the injured
(14:09):
worker that the injured workerthemselves did not see.
But they can also help,corroborate or impeach the
injured worker or otherwitnesses.
In fact, I had a claim recentlywhere one witness supported
what the injured worker said andthen two others completely
contradicted those stories.
So it's really important tospeak not only to a witness but
(14:32):
to all of the witnesses.
Speaker 1 (14:35):
And that's an excellent point.
Sometimes when we get in thecheck the box mentality, where
we talk to the injured worker wesay okay, there's a witness,
and we talk to the witness andwe move on without really
thinking about the whole picture, we can get ourselves in a
little bit of trouble and missout on all the information of
what exactly happened.
So I'm glad that you pointedthat out.
(14:56):
One of the other things thatyou talked about there that I
thought was interesting youtalked a little bit about first
reports of injury and I thinkboth Matt and you hit on
something that sometimes what'son there either we don't
understand it or it might notalways be accurate.
I know we've seen times wherewe've had a claim reported as a
medical only claim, only to findout that it's much more severe.
(15:16):
I can think of one that we had,that said, a head laceration,
and we found out later that hehad had a grinder go through his
forehead, which is a lotdifferent than a head laceration
, obviously.
So we're talking about a veryserious traumatic brain injury.
Luckily the injured worker didrecover from that, but we didn't
know about it initially becauseit had been classified wrong.
(15:37):
Carol, can you talk a littlebit about first reports of
injury and the importance ofkind of confirming with the
employer what actually happened.
Speaker 3 (15:45):
Yeah, I think a first report of injury is sort of my
first line of investigation.
So as soon as I get a new claimcoming in whether it's new or
even if it's a few weeks ormonths old I always start with
the first report of injury.
Not only does it give you asummary of what happened, but it
also says who reported theclaim and it gives you an idea
of where the employer is located, where the accident occurred
(16:08):
and where the injured workerlives.
That's important becausesometimes those aren't always in
the same city or even state.
So if you've got an injuredworker who's seriously injured
in Ohio but they live in Texas,you've got some work ahead of
you to try and get them home forrecovery where they have
familial support and where theycan be with their belongings and
(16:33):
have to move doctors from wheretheir original injury was to
their home state.
So those are all importantthings to know.
Going into a claim.
It's also helpful to confirmthat you're in the right
jurisdiction to be sure that theclaim was reported correctly,
and that's certainly importantbecause every state has
(16:54):
different laws.
You want to be sure you'rehandling the claim in the
correct jurisdiction andfollowing the correct laws.
And sometimes those firstreports of injury also identify
the people you need to talk to,obviously not only the injured
worker, but the person whoreported the claim.
You certainly want to speak tothem, and sometimes they also
list the witnesses and theinitial medical provider.
(17:17):
So that's all really importantinformation and kind of your
first step on the investigationjourney.
Speaker 2 (17:23):
So where does empathy fit into the claims
investigation versus ajust-the-facts-ma'am approach to
investigation?
Speaker 3 (17:32):
I think the point of the investigation is certainly
not to drill the injured worker.
So sometimes we can get intothe habit of going through just
the questions that we'vedeveloped or perhaps that are
even on a recorded statement.
Instead of just going throughbasic questions, we want to
listen to the individual.
(17:52):
There's multiple reasons forthat One.
They're a human being and theydeserve to be listened to, and
that is a way of showing empathynot just waiting for them to be
done talking and moving on tothe next question, but genuinely
listening and hearing what theyhave to say, hearing what their
concerns are.
Sometimes there's follow-upquestions that need to be asked,
(18:14):
and so that's important as well.
But again, the point of aninvestigation is not to drill
someone.
We're meeting these people atsome of the lowest points in
their lives.
They're hurt, they're scared,they don't know how they're
going to provide for theirfamily, and it's our first
chance to not only investigatethe claim but to explain the
(18:36):
workers' comp process and builda relationship and a rapport
with them and tell them whatwe're going to do to try and
help them get better and providefor their family in this scary
time.
Speaker 1 (18:47):
I think you really hit on some really important
concepts there, and I think,unfortunately, there's a thought
process that insurancecompanies are looking for ways
to deny claims and ruin people'slives, and that's just, you
know.
Obviously, our goal is to dothe right thing and we want to
do the right thing for everybodyinvolved, and it is a balancing
act because we have a policyholder that's paying us a
premium, we have an injuredworker who's hurt.
(19:08):
There's a lot that we're tryingto do when we say do the right
thing.
And empathy, in my opinion, iswhere it starts.
Obviously, you know, I think ofour injured workers a lot, like
I do my children.
I know people say I have, youknow, I talk a lot about how I
have six kids, but you know, Itrust my children to a point,
because I remember I was a kidonce too, and I was a pretty
(19:30):
good kid, but my parents didn'tknow everything I did, you know.
So we hope that our injuredworkers are always coming at
this with the right attitude andthe right thoughts.
But you know, we do have tomake sure that all the facts
line up and that what we have isa compensable claim before we
start paying for something thatmaybe isn't, and we've seen some
examples of that.
(19:50):
Unfortunately, they're theminority, but they do exist.
So, when you are taking astatement, why is it important
on our end to keep our ownjudgments and assumptions in
check?
Because obviously we all haveour own biases.
Speaker 3 (20:04):
Wow.
Well, I think, first of all,it's just a good life skill to
develop.
We want to treat everybody aswe want to be treated and not be
judged or have assumptions madeabout us.
But I think specific toinvestigating a claim if we
assume, we're usually going tobe wrong and if we don't ask, we
(20:25):
don't know.
So in order to investigatethoroughly, we need to know what
we don't know and then we canask the questions.
And again, so much of thatstarts with follow-up questions
and listening to the injuredworker, not just moving on to
the next question.
If we just hear the basicinformation that they're willing
(20:47):
to share right off the bat andnot dig in and ask further
questions, there's going to be alot of information later down
the road that you realize youdon't know and then it's harder
to go back and ask that persondetails later.
For lots of reasons, Memoriesfade, attorneys get involved,
(21:08):
and if we can ask the questionright at the beginning, then we
have a very clear understandingof the facts.
And that goes for investigatinga claim with compensability,
but also things like hey, what'syour house like?
Do you have a lot of stairs?
Is your bedroom on the firstfloor?
If someone's severely injuredand they're going to end up
(21:31):
going home after some time inrehab, we need to know what kind
of modifications might beneeded for their home or what
sort of equipment they mightneed to serve them best while
they're at home.
And it's a lot easier if youknow all that information up
front than trying to chasesomebody down to get that
information later.
Speaker 2 (21:49):
Yeah, if there's family, friends who lives with
them, all that good stuff thatyou're going to be asking.
So, there's generally a lotgoing on during that initial few
days of the investigation.
What are some of the otherdocuments that you like to
obtain and review during yourinitial investigation of a claim
?
Speaker 3 (22:06):
Yeah.
So again, the first report ofinjury is where I start and then
I usually go to an index report.
So I'm looking to see if theyhave prior injuries that pertain
to this claim.
Are they litigious?
Can I expect an attorney onthis claim?
And when I'm looking at priorinjuries, I'm not just looking
at oh, this is a shoulder claim.
(22:26):
Have they had a shoulder injurybefore?
We all know that body parts areconnected, so a prior head
injury or neck injury might berelevant to this shoulder claim,
because we all know that a lotof neck pain can go into
shoulder and vice versa.
I'm also looking at the policyto confirm coverage.
(22:46):
I'm looking at medical recordsto confirm that the mechanism of
injury matches what I know tobe true, what their medical
history is and whether or notthat might impact recovery and
healing.
Somebody who's a diabetic and apack a day smoker and has a
injury.
That's not a good thing and Ineed to be aware that their
(23:09):
healing is going to take alittle bit longer.
And then again I'm looking atwitness statements that maybe
have already been taken by theemployer.
Sometimes there's writtenstatements from witnesses when
insureds can provide their owninvestigative reports that
they've done.
That's super helpful.
It's again another take on whathappened to cause the injury.
(23:31):
If there's photos, those arereally helpful.
Instead of imagining thescenario, I can physically see
it videos of the injury or evenjust of the job that the person
was doing.
So, for example, I had adriller who had a drill come
down a very large drill, miningdrill come down on his foot.
(23:52):
I didn't understand what hewould have been doing at the
time and how this injuryoccurred.
The employer was able to sendme kind of a series of photos
explaining the job that he wasdoing and that way I was really
able to piece together whathappened to cause the injury.
So those things are all reallyimportant to have.
Speaker 1 (24:12):
One of the things you were mentioning.
You know getting videos orphotos from the insured One of
the things that's been morecommon that I've seen and I'm
wondering if you've seen this asdash cams or surveillance video
, like at a gas station orsomewhere else.
You know that that has, likeyou know, security video footage
and police cams now are a newthing that we're starting to see
(24:34):
more of.
So have you seen any of thosethings play into your
investigation?
Speaker 3 (24:38):
Yeah, I've had a couple instances where the
insured's closed circuit TVsystem has really helped.
It's shown the injury or hasshown aftermath.
I suppose you would say we canconfirm timing, we can confirm
who was there.
Sometimes we can see the injuryitself happen.
If a third party is involved,we have evidence or proof of
(24:58):
that.
In terms of subrogation, that'sbeen really helpful.
The black boxes in vehiclesmost modern vehicles now have
their own version of a black box, so that can be really helpful,
especially with motor vehicleaccidents, to determine how fast
the vehicle was going whensomeone started braking, the
(25:19):
timing of impact.
Those sorts of things have beenreally helpful to have as well.
Speaker 2 (25:24):
Sharon, I think you hit on a word that I don't know
if we've had this topic onsubrogation and maybe we have,
but that's a pretty big thingfor an insurance company.
Workers' comp is no fault.
But if there's another partythat you mentioned like flips
from heights or falls, safetyequipment where it's either you
know it's failed or somethingelse has failed, or a motor
(25:46):
vehicle accident, all those kindof raise another level of
investigation right aroundsubrogation.
And is there another party atfault?
Is there another potentialrecovery available for both the
injured employee and, you know,the insurance carrier
potentially?
So I mean, I think that's a bigpart of that in this
investigative piece that youknow we could probably spend a
whole nother podcast justtalking about subrogation in
(26:06):
general.
So you know.
So there's lots of things youknow, I know from being on the
front lines and doing thoseinvestigations.
You know there's you startopening up, you know, what could
seem like a Pandora's box ofinvestigation on some of these
claims, the more complicatedthey are.
So what's an important you know, and you mentioned mechanism of
injury earlier too.
So why is that important foryou to use and what's you know,
(26:29):
what's that going to helpexplain, you know, for you
during the investigation of theclaim.
Speaker 3 (26:34):
I think the mechanism of injury is important for
several reasons.
It's going to again help usdetermine that the injured
worker was doing their job, wasworking at the time of the
injury.
It's going to help us identifyfuture safety issues.
You know, if the job thatthey're doing is unsafe and
that's what caused the injury,then how can we make it safer in
(26:58):
the future?
That's something that our rampteam and our underwriting team
both need to be aware of.
If safety issues like that areidentified, specifically ones
that we've seen before over andover with the same insured, I
think making sure that themechanism of injury and the
diagnosis itself makes sense isimportant.
(27:19):
I have no medical background,no medical degrees, but just
common sense comes into place orplay Sometimes, you know being
sure hey, if something fell andlanded on my left foot, then why
does my shoulder hurt?
You know things like that.
Speaker 2 (27:36):
Yeah, I mean, I think there's a lot of truth to that.
How do you improve something sothat you know we can prevent
this injury from occurring?
How do we ensure that we'reputting our injured employees in
the best possible position toboth be successful for whatever
organization they're working for, and to return back home every
night for their families?
So I think that investigationis an important piece of how do
(27:57):
we improve the process to avoidthis ever happening again and
ensure they're preparing for anappropriate loss.
I know Greg has a final questionfor you too.
Speaker 1 (28:07):
Yeah, well, I actually just had a couple of
thoughts I wanted to pick yourbrain on as we wrap things up,
but one of them was so havingdone this, carol for coming up,
I don't think you're gettingclose to 20 years now doing this
.
If you could go back and tellCarol in year one don't forget
to do this part, because I'velearned a lot in that time what
would be the thing that youwould say, hey, you know.
(28:28):
Going back and telling you 20years ago, what would you tell
yourself, don't you know?
This is the part you need tonot forget about it.
On a claims investigation.
Speaker 3 (28:37):
I think there would be two main things I would tell
myself.
The first would be, again, notto stick to that recorded
interview script.
I think initially, whenworkers' comp adjusters are new
at investigating, we can getnervous and hyped up about
wanting to develop a rapportwith someone.
(28:57):
But also be sure we thoroughlyinvestigate and we get
overwhelmed easily on the phone,especially if a conversation
goes in a direction that maybewe didn't expect it to go.
So, really having sort of a listof questions typed up or
written out on a note that Iwant to be sure and ask it's not
(29:19):
necessarily what's on arecorded statement script, like
I need your address and date ofbirth and those sorts of things
those become common sense to askor to verify.
But to really get to the heartof that specific person's injury
and not use generic questionsand listening to their answers
and asking follow-up questions.
(29:39):
That would be the first, andthe second I think it ties in
with it is to be empatheticbecause again, as a new adjuster
, you're so concerned aboutbeing sure that you get all the
questions answered that you canget into this robotic like tone
almost, and you forget thatthese, this person, has a life
(30:02):
when they hang up the phone withyou and they have questions and
they're scared, and so if youcan make them feel better by
providing answers to theirquestions and giving your
contact information really basicstuff that seems like common
sense, but sometimes us newadjusters are so busy that we
just got to get our questionsanswered and get off the phone
(30:23):
so we can move on, and that'sreally harmful to both parties
when we do that.
Speaker 1 (30:33):
I'll tell you what, carol.
I'm so glad that I had you onthis episode, because the things
you highlighted, I just thinkare missing in a lot of people
in this industry, so I'm gladthat you pointed that out the
curiosity, asking questions,good questions and really trying
to understand.
And then, I think, the otherpiece of being sure that we show
empathy and that we don'tforget that they're going
through something difficult,regardless of what our job is,
(30:53):
to make sure that we do thosethings is something that the
whole industry could learn alittle bit from you on.
So thank you for highlightingthat.
You know, one of the things Iwanted to highlight this year,
as we move into 2023, is Iwanted to ask each of our guests
something that they're gratefulfor.
I feel like we live in a worldwhere there is very me-centered
(31:16):
culture, and so I'm going to tryto, this season, put some,
again, good vibes out in theuniverse, and my thought is just
to ask people what are yougrateful for?
Speaker 3 (31:24):
I'm grateful for my family.
I have a fantastic husband andtwo really great daughters, 10
and 13.
And then I have extended familyclose by that we have great
relationships with and that areable to help when we need it.
And I'm grateful for my job ascorny as that sounds, I work to
(31:46):
live, not live to work.
And my job allows me to keep mymind busy and be intrigued and
to learn, but most importantly,it helps me to continue doing
what I love doing, which isbeing with my family and
enjoying my time and providingfor them.
Speaker 1 (32:04):
Well, I absolutely love that, Carol.
I think that's obviously a lotof the reasons why we do what we
do and really appreciate havingyou as a guest today.
And we'll just remind folks ourtheme to do right, think
differently and don't forget tocare.
And with that we will wrap upthis episode and hope you'll
follow us in future episodesreleasing every two weeks on
(32:25):
Monday.
You can also catch our blog onthe off weeks that is written by
our wonderful Natalie Dangles.
So again, remind everybody todo right, think differently and
don't forget to care.
And that's it, guys.
Thank you.
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