November 13, 2024 • 37 mins
Join Sandy Avina, Claims Service Manager at California Schools JPA, as she discusses how kindness can reshape the workers' compensation landscape. By treating injured workers as individuals and focusing on their well-being, organizations can reduce litigation, speed up return-to-work times, and combat compassion fatigue among adjusters.
Sandy also explores strategies to improve workplace culture, build trust, and foster stronger employer-employee relationships. The conversation touches on the importance of mental wellness in the industry and offers practical steps to support mental health, providing valuable insights for anyone seeking a more empathetic approach in the workplace.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Perspective.
Perspective is spelledP-E-R-S-P-E-C-T-I-V-E.
Perspective the 30,000 footview.
Perspective put on someoneelse's shoes.
Perspective can also refer tothe state of existing in space
(00:20):
or one's view of the world.
Perspective R-E-A audio.
Speaker 2 (00:30):
Reemployability.
What is the kindest thing thatyou've done for someone this
week?
Think really hard.
Was it for a friend or a familymember, Someone at work, Maybe
a stranger?
And we all know what kindnessis.
But what we experience in ourhearts as a kind act is relative
and depends a lot on context,and sometimes it actually feels
(00:50):
better to do the kindness thanit feels to have the kindness
done to us.
Look, I love my mother-in-lawTruly.
She's a giving, caring,selfless person, but what she
perceives as kindness sometimesis overwhelmingly overbearing.
She'll take on projects and dothings even when she's asked not
to, and it comes from her heartbut isn't always necessarily
(01:12):
regarded as kindness.
Now, on the other hand, thereare times when I could be kinder
or even just do something kindand choose not to.
Have you ever been in a mood andnot let somebody merge in front
of you on the highway or maybenot paid as close attention to
your kids as you should have?
Kindness is defined as thequality of being friendly,
generous and considerate, andNovember 13th is celebrated as
(01:35):
World Kindness Day, a globalobservance dedicated to
promoting and celebrating actsof kindness.
So we thought we'd take thisopportunity to help put kindness
into a different context whenit comes to dealing with all the
players in the workers' compgame, no matter what position or
role you're in.
Sandy Avena is the ClaimsService Manager at California
(01:56):
Schools JPA and a super creativefrequent poster on LinkedIn.
The perspectives and approachshe takes at California Schools
JPA utilizes small, simple bitsof kindness to make tremendously
powerful impacts in the livesshe and her team interact with.
Speaker 1 (02:13):
Kind means generous, helpful and thinking about other
people's feelings.
Speaker 2 (02:17):
California Schools JPA.
Tell us what that is and howdid you get involved with it.
Tell us what that is and howdid you get involved with it.
Speaker 3 (02:24):
So in California they allow public entities to come
together to form a uniqueindividual legal entity for the
purpose of purchasing insurance.
And that's what a JPA is.
It's a joint powers authority.
So you'll see that a lot withcities and counties and school
districts where we come togetherand we form a JPA, and that's
what California Schools JPA is.
(02:44):
So clearly we care to publicschool districts and community
colleges and our JPA is uniquebecause we actually have two
JPAs under our umbrella.
So one of them is for employeebenefits, that type of insurance
, and the other side is for riskmanagement.
So your workers' comp, yourproperty and liability, and I've
been here for five years nowand just really excited to be
(03:04):
part of this risk pool thatserves school districts and get
to work with educators and thefolks who are in charge of, you
know, educating the nextgeneration.
Speaker 2 (03:14):
Well, and what you do .
You take a little bit differentapproach with your injured
workers, as we were kind oftalking about before we came on,
and I think you know.
I want to also preface thereason, sandy, why I had
actually asked you to come onthe podcast.
You are very active on LinkedInand you had made a post that
(03:34):
really caught my attention withregards to an article that you
wrote in Blue Magazine aboutcompassion fatigue in the
insurance world, and you knowREA Audio.
We always try to focus on theinjured worker as a human being,
not just a number on aspreadsheet.
And when you talked about, youknow, adjusters and what
(03:56):
compassion fatigue is, and we'lltalk about that in a little bit
.
You know I'm guilty of notalways thinking that way about
the adjuster, right, I'm alwaysthinking about injured worker
and how can, what can adjustersdo to be better in tune with
injured workers, but we forgetabout the other side of things
and the constant pressure andthings that adjusters and folks
(04:21):
on the insurance end you knowhave to deal with.
And, like I said, we'll talkabout that in a few minutes and
how you're addressing that,which is really important.
But what you're all doingcurrently you take a little bit
of a different approach withinjured workers.
I think kind of similar to whatwe do at reemployability, as
far as looking at them as like ahuman being right.
Speaker 3 (04:42):
Yeah, I think what makes our program unique it's
something we're really proud ofis we formulate everything in
terms of what is best for theemployee experience in workers'
comp.
And a lot of programs.
Look at cost containment.
When you hear about workers'comp programs, the key word is
cost containment.
What are we doing to containcosts?
But cost containment has apoint of diminishing returns.
(05:04):
If you have somebody who'sinjured, your costs are never
going to be zero.
You're always going to havecosts, and sometimes we're
controlling costs that are thesymptom of a poor employee
experience, right.
So litigation can be the resultof a poor employee experience
and then that increases yourcosts, so we kind of flip that.
So instead of focusing so muchon the cost containment, we
(05:26):
focus on what can we do to makesure that the injured worker
knows that they are valued, thatwe care about them, that we
want to make sure that they arereceiving quality treatment,
that they receive it timely,that we are helping them
navigate this process and we'reestablishing that trust with
them, and that, in turn, isgoing to end up controlling your
costs, because they're lesslikely to get an attorney
(05:47):
because they're returning to theworkforce sooner.
So a lot of the design of ourprogram comes from what is the
experience like for the employee, and part of that is the
adjuster right, so it's theyhave to build that relationship
with the employee.
And when I was an adjuster, Iremember what it was like to be
in that world.
It can be a very thankless job.
It can be a job where you havevery high caseloads and that
(06:10):
diminishes your ability to carefor somebody appropriately right
Because you're barely able totake care of yourself.
It is exhausting and you reachburnout.
And a lot of adjusters who dobecome jaded.
It's not that they don't care,it's a method of protecting
themselves.
And so nobody should be in thatsituation where we're just like
(06:31):
in survival mode to get throughthe day because that's a poor
that ends up being a poor resultfor the injured worker.
So for adjusters, in ourprogram we cap the cases at 125.
It's in our contract with ourTPAs and we want that low
caseload because we want theadjusters to have time to
develop that relationship withthe employees, to build that
trust.
(06:51):
And then that in turn means thatthey have less litigation.
So our litigation rate for thelast four years has been between
two and four percent.
Super proud of that because inCalifornia the average according
to WCIRB, they're thestatistical insurance agent, the
statistical agent for workerscomp.
In California, 11 percent isthe average.
Speaker 1 (07:13):
Wow.
Speaker 3 (07:14):
Significantly lower than the average in California
and that really goes to showwhen you focus on employee
experience you bring down yourlitigation.
That brings down your overallcost, so that focusing on the
employee first really does havea great ROI.
Speaker 2 (07:28):
So my, my wife is a teacher.
We're in Florida so obviouslythe setup for the teaching may
be different from state to state, from county to county.
(07:50):
However you have it set up, Ibelieve people who get into
teaching get into it.
For most of the time it'sreally really good reasons and I
think teachers can get jaded aswell, right?
So it's important to kind oflook at them and look at them
with some a little bit of adifferent perspective, I think,
than some other folks, not totreat them any differently, but
just understand.
(08:11):
I think you know there's acertain mentality that gets you
into teaching and when thosepeople are injured on the job or
even other folks in theeducation system, I think that
different approach certainlyhelps to get them recovered
faster.
Now is what you're doing withCalifornia Schools, jpa, and the
approach you're taking.
(08:31):
Is that unique to yourorganization, like in all your
previous experience in workers'comp and insurance?
Is this a different approachthan what you're used to?
Speaker 3 (08:43):
Oh, very much so.
So I have experience on the TPAside and I have experience on
the insurer side.
And on the insurance side youreally are looking at cost
containment because you have tostay solvent.
But for a risk pool, our focusis the employer and that's
something that not that the TPAsand carriers don't consider,
(09:04):
but that's not top of mind forthem.
For us, we want the employer tohave a good relationship with
their employee.
That's the difference of therisk for employer focus.
So we're looking at not justwhat can we do to contain costs
for claims, but how does thisrelationship carry on after the
claim is over?
Right, and that goes back tothat employee experience,
(09:25):
because experience is going tocompound positively or
negatively.
So if they have a badexperience, they're telling
everybody, they're tellingeverybody, they're telling their
co-workers they're putting areview on Glassdoor.
They're going to be on LinkedIn,but if they have a positive
experience, that compounds too.
So that's the different focusis we want them to have a good
relationship with their employer, because at some point they
(09:46):
have to go back to the workforceand we want to reinforce that
positive culture.
So that's really important tous in a way that you don't
necessarily see that focus withinsurers or TPAs.
And that is the beauty of JPAsand risk pools, because you have
that ability to be morecreative in designing your
program that is more focused onthe employer and the
relationship with theiremployees.
Speaker 2 (10:07):
So, practically, can you tell us some of the things,
some of the actionable thingsthat you do to help improve that
relationship?
Speaker 3 (10:13):
Absolutely so.
On top of the case low cap wehave a pass through program for
utilization review.
So in California we have autilization review process where
treatment has to go through URto determine whether or not it's
appropriate.
But there's a very low level ofauthority that the labor code
allows the adjuster to authorizeat their desk level.
Because we're a risk pool andwe have flexibility, we allow
(10:34):
the adjusters to authorize muchmore treatment than what's
outlined in the labor code.
And the purpose of that is Idon't want the employee waiting
for something to go throughutilization review, to wait for
it to be reviewed, to get theapproval letter, and delay the
care.
When it's somethingconservative, like physical
therapy, over-the-countermedications, those are the sorts
of things that the adjustershould be able to do at their
level to get the employee careas quick as possible.
(10:56):
So we let the adjustersauthorize a lot more at the desk
level and we also listen to ouradjuster's suggestions.
So if they say, hey, this wasdenied by utilization review,
but I think it should beoverturned and here's why why we
have the low case, low cap, sothat they can develop the
relationship and they can say,hey, I built this relationship
with this employee.
I think if we just get thisadditional chiropractic
treatment, I think this is goingto be good and we're going to
get them to MMI and we're goingto be able to resolve the case.
(11:19):
Great, let's do it.
So we're looking at what can wedo to make sure that we build
in that relationship.
We trust the adjuster to getthe employee the care that they
need.
We also have a greatoccupational management program,
occupational clinic managementprogram, and we'll go down to
(11:39):
the clinics.
We develop relationships withthe operations manager at the
clinic.
We talk about things like waittimes, about the timeliness of
reporting, about ambiguity withwork restrictions.
That's a big one.
So if a doctor writes a workrestriction that says no heavy
work, that ends up creating alot of issues with the employer
and the employee because we mayhave very different ideas about
what heavy work means right andthen the employee's like, well,
that's not what I think it meansand that breakdown in trust
(12:00):
starts.
So making sure that there'sclarity from that from the
get-go, so that it creates aeasier interactive process for
the ADA, so the employer canbring them back and everybody
knows okay, no lifting with yourright arm over 10 pounds.
We all know what that means andthat makes it easier.
So making sure that we havethose relationships and we fix
those problems at the root issue.
(12:21):
And then we also have a managertraining, because I've seen in
the past, in my past experience,a lot of employers will go
radio silent on an employee oncethey're off work, for whatever
reason it's either.
They well, they're off work, Idon't have to talk to them at
all and it's really confusingfor the employee because they
often think they're beingpunished.
I haven't heard anything frommy employer, nobody's reached
(12:44):
out to me.
And then sometimes there'sconfusion because they'll call
the adjuster about things theemployer sends.
Well, I got FMLA paperwork.
What does this mean?
So it's just making sure thatthe managers understand hey, you
can still keep in contact withyour employees, you can still
say, hey, like hope, you'regetting better.
Let them know that you don'thave to ask for a diagnosis, but
you can still have a humanconnection with somebody and
(13:06):
facilitate that return to workprocess, because the employees
don't know that they're wantedback, that's the key is we want
to make sure that they know wewant them back, they're not
being punished for having aninjury.
We don't think that they're lessthan than having an injury.
And then the last two itemswere really specific to our
program.
One is a get Well Card contest.
So for our school districts wehave a contest periodically
(13:27):
where the students all submittheir artwork and then some
winners are selected.
The winners get gift cards andthen we take that winning
artwork and we turn it into GetWell Cards and then we give
those to our districts to giveout to employees when they're
off work.
So it's just a nice touch toget something in the mail.
It's not just to get well cardbut also get well card that was
made by the kids in yourdistrict that you work for.
So it's a super awesome program.
(13:48):
It's something that I don'tthink I've ever seen before in
my prior experience outside ofthe JPA.
And then the most recentaddition we've had is a
partnership with Kind SoulsFoundation, and I don't know if
you're familiar with Kind Souls.
Speaker 2 (14:00):
Oh yeah, very much, Great, great organization.
Speaker 3 (14:03):
Yeah, we were really excited to partner with them
because I think that really is amissing gap in the claims
process is there's statutorybenefits under workers comp, but
sometimes somebody who has adisability has needs outside of
what workers comp can provide.
But it's less than I normallymake and I'm having trouble, you
(14:23):
know, being able to cover basicnecessities.
I'm having trouble affordingfood or maybe I need affordable
child care.
Workers can't really help withany of that, but kind souls can
they give you those resources.
But they also follow up withthe employee and that's the
component I love.
It's not just the 800 numberwhere you call and you say, well
, do you have resources?
In my area they're following upto say, hey, how did that go?
(14:46):
Did you use the resources?
Did that work out for you?
They're looking for thatfeedback and then they follow up
again.
So it's just I wish I wouldhave had that as a resource when
I was an adjuster for employeeswho are struggling, because you
do have people who reallystruggle financially as a result
of their disability.
Yeah, of course, and workersworkers comp doesn't cover
everything.
It covers a statutory benefit.
So it is a great way to againcreate a better employee
(15:09):
experience, provide them alittle extra outside of the
workers comp through theseadditional resources, and so all
of those are steps that we havein parts of our program that
again reinforce what are wedoing to take care of the
employee.
No-transcript.
Speaker 2 (15:30):
As part of my role at re-employability, I get to
travel around and speak with ourclients, but while I'm on the
road I always make sure to visitthe nonprofits that are our
partners.
No matter where I am, there'salways a nonprofit and many
times they will have injuredworkers that have been placed
there through our program.
Too many times when I'll talkwith the injured worker I'll
hear a story like you know, wegot the job offer letter in the
(15:53):
mail and I showed up here and Ireally didn't know what to
expect.
It's because the employer isafraid, and I think that's
really what it is.
It comes down to fearno-transcript, but but employers
(16:28):
are afraid to position it thatway and talk to them about it,
and so they just kind of punt itover to us and let us send out
the offer letter and hope thatthe injured worker shows up.
And it is.
It's really sad and you knowit's the little things that
you've mentioned in everythingthat you do.
It's not necessarily earthshattering, world changing
things that you're doing.
You're sending out cards topeople you know I mean seriously
(16:48):
Kind Souls Foundation.
What tell me about the level ofrelationship?
Like, what do you do?
Do you just let them know thatit's available, or how does that
work?
Speaker 3 (16:58):
So for Kind Souls Foundation we have a flyer that
goes into the new loss packetthat the employers hand out,
right?
So once the employee files theinjury, the employee gets a new
loss packet and it'll have aflyer in there with information
and so that way they know it'savailable there.
But we also let our TPAs knowthat we're partnering with them
so that if the adjuster istalking to the injured worker
(17:18):
and they mention something, theycan make sure that they use
that as a resource.
Yeah, and we've also made surethat the HR teams with our
employers know that this isavailable.
Because what I love about KindSouls is this fits into work
perfectly because they reallyservice anybody who's had a work
displacing event.
But that could be anythingoutside of Workers' Comp, right?
Somebody could be on FMLA, formaybe they're a caregiver, maybe
(17:41):
they are on Workers' Comp for anon-industrial condition, so
anything that really is a workdisplacing event.
They can access Kinesals.
So we tell our HR teams this ispart of our Work Comp program,
but by all means make sureeverybody knows that this is a
resource.
And we even had someconversations recently with our
districts who said you know what?
This might actually be?
(18:02):
A great parent resource.
Some of our districts haveparent resource Web site pages
where they can make sure thatyou know this affects parents
too.
Some parents may have a workersplacing event, so really just
spreading that word because itreally supports not just the
injured workers but theemployees of the district.
The parents of the studentsthat attend Just really excited
about the applicability of thisservice to everyone in the
(18:24):
community.
Speaker 2 (18:25):
It's a matter of just saying something right it's
about knowing the resources thatare available and telling
somebody about it.
You know this is I hope thisdoesn't come across as goofy it
I hope this doesn't come acrossas goofy, but I had an epiphany
one time when somebody told methat it was okay to give
somebody a compliment.
You walk by somebody in theoffice and you're like, hey,
your shoes look nice today.
(18:46):
A lot of times I would justthink it and not say it.
You have no idea how justsmiling at somebody passing them
in the hallway or making a kindcomment that maybe you thought
but didn't want to say, or forwhatever reason, just didn't say
, say it, give peoplecompliments, smile to people.
You have no idea how that'sgoing to impact their lives.
(19:08):
You know, you never know whensomebody is going to need that,
and I think that says a lotabout the way your program is
moving forward with regards tojust those little things that
make huge differences, isobviously translating into great
successes, for what yourorganization is doing.
Is this scalable company?
(19:30):
Do you see this approach beingable to, you know, take over the
industry in a way that mightbenefit others who aren't able
to be a part of yourorganization?
Speaker 3 (19:42):
I think it absolutely can, but it needs to come from
the employer level, as opposedto the TPA and the insurer,
because at the end of the day,this has to fit in with the
employer's value system, right?
So if you have a TPA or carrierwho says, hey, you should
implement this, but theemployer's like, nah, I don't
think we want to do that.
Our managers don't really wantto talk to them once they're off
work.
Then that's the disconnect,that's the problem.
(20:03):
So it really does have tohappen at the employer level,
and then your TPAs and yourcarriers can be partners in that
.
But any organization, I don'tcare who they are your employees
are the greatest asset you have.
So I don't know why anyonewouldn't want to take this
approach.
I think there's an ROI tokindness.
Speaker 1 (20:25):
That's the hill to die on.
Speaker 3 (20:26):
Yeah, there really is , and our program really is
evidence of that, and I hopethat with that success, other
employers will see that and say,oh, we might be able to do this
at our level as well, and if wetake care of our employees,
we're going to see that costcontainment just as a result of
that, as opposed to making costcontainment the central focus
(20:48):
and not really looking at theemployee experience.
Speaker 2 (20:50):
Have you faced any hurdles within the organization
in implementing any of thesethings?
Speaker 3 (20:54):
Have you faced any hurdles within the organization
in implementing any of thesethings?
I think not within theorganization, but just
explaining to people, the ROI.
So in a very metrics-drivenworld, which insurance is,
sometimes it can be difficult toexplain.
Here's how we're going toreduce costs by focusing on
employee experience, becausepeople are used to looking at
(21:15):
specific metrics and we see thatas the result.
But in the beginning these aresoft benefits that it can be
sometimes difficult to measureand project.
But we have really great schooldistrict members.
We have a fantastic board whoabsolutely believes in taking
care of their employees, becausethey know that their employees
are the ones taking care of thekids in our community.
(21:36):
So, they are all in with it, soit's just making sure that they
understand the benefit, but whenwe bring these benefits forward
they usually are all in becausethey know that's going to
create a better relationshipbetween the district and their
employees.
Speaker 2 (21:48):
So, with the folks that work and take this approach
, you know again, going back tothat article that you wrote in
Bloom about compassion, fatigue,talk a little bit about how
this approach helps folks on theadjuster side who are taking on
these, I guess, additionalresponsibilities.
To be nice.
I mean, I hate to say it, butwhen you get into that mindset
(22:10):
of checking the boxes becauseI'm overloaded and I just have
to get through this one to getto the next one, you are asking
people to pause, step back andkind of reevaluate their
approach.
Do you see that that helps themental wellness of the people
that are actually taking theapproach, those adjusters?
Speaker 3 (22:28):
I think it does, because it's making sure the
adjusters understand the benefitthat they provide and that this
really is about communityservice.
So some adjusters and again itdepends on the account that
you're tied to, because someaccounts have a very different
approach Some accounts are notcommunity-minded, they're not
(22:49):
focused on employee experienceI've worked with challenging
accounts in the past.
Experience they can be.
You know, I've worked withchallenging accounts in the past
and that can really be verydefeating as an adjuster because
it makes it difficult for youto really help somebody If you
know that the employer is notengaging in the interactive
process, they're not acting ingood faith and that can be
(23:12):
stressful because you want to beable to help.
But if you have a client who isnot community minded and they
don't want to help or saythey're just going to control
their costs, that becomesstressful.
That really feeds into thatburnout and that compassion
fatigue because you feel likeyou're steering the ship by
yourself.
You're trying to help thisemployee but you know that
they're not getting any help onthe employer's side or there's
no resources for them outside ofjust the workers' comp benefits
(23:36):
.
So in the Bloom article I talkedabout my own experience of you
know somebody who had a reallycatastrophic injury and the
employee's wife had called andshe was just struggling just
with what this meant for her andher family.
The employee had beenhospitalized for several months
and I really it just hurt myheart because I felt like I had
(24:00):
nothing else to give her outsideof statutory benefits.
And when we designed thisprogram that really is the goal
is for adjusters to know thereare other things you can offer
the employees outside of justthe statutory benefits, and
that's the resources that theemployer partners with so Kind
Soul Foundation, the Get Wellcard, making sure that the
employee feels supported, andthat way it's not the adjuster
(24:23):
carrying that load, becausethat's a lot to put on the
adjuster.
If the employee is getting nocommunication from the employer,
then who's getting the callsfor the insecurity and the fear
and the anxiety that theemployee has?
Speaker 2 (24:34):
The adjuster is.
Speaker 3 (24:36):
And we don't know how to answer those questions if
there's no communication fromthe employer.
So it puts the adjuster in areally bad spot when there's no
communication from the employer.
Or, even worse, there's badcommunication from the employer,
where the employer is makingcomments like oh, you know, must
be nice to have a paid vacationor, you know, we're all having
to work harder because you'regone and we all had to pick up
(24:57):
your slack.
That makes the employee feelworse and then they call the
adjuster because they don'ttrust the employer.
So that just puts thatadditional burden on the
adjuster and that againcontributes to that burnout.
So I think that really is.
The difference here is we'retrying to create a positive
environment.
So it's not the adjuster justgetting the call, where they're
being dumped on for everythingor because they're the only one
(25:18):
who's communicating with theemployee.
They are now just the personwho gets the blame for the lack
of communication with theemployer.
You know, for their poor medicalexperience.
With medical care, the adjustergets blamed for things that are
outside of their control, right.
Speaker 1 (25:34):
Yeah so that's.
Speaker 3 (25:35):
I think that really does help.
If you have a program that isfocused on employee experience,
on a positive employeeexperience, it just creates a an
environment where the adjusterreally is able to focus on
relationship building with thatemployee, as opposed to it being
purely negative.
Speaker 2 (25:53):
So all these things we talk about really relate to
mental wellness and mentalhealth, and that's a big
buzzword now.
Everybody talks about mentalwellness and you even talked
about it in your post onLinkedIn today about you know,
it's a trendy.
You didn't say trendy, I'msaying trendy, but it's a trendy
thing to talk about andeverybody's quote-unquote aware
(26:15):
of it.
But what actions can peopletake to improve that mental
wellness?
Because, as an injured worker,you need to be able to take
those steps.
As an adjuster, you need to beable to take those steps, and it
sounds like there's a lot ofemployers that need to take that
step as well, because, at theend of the day, if we're all
just in better mental fitness orbetter shape, we're going to be
(26:37):
better people to each other.
So talk a little bit aboutmental wellness and some of
those actions you can take.
And then mental health firstaid, which is really really
interesting.
Speaker 3 (26:47):
So I'll start with a little story about how I found
out about mental health firstaid.
I worked for an employer, ahealth plan about 10 years ago.
They sent all the managers to aclass and it was a mental
health first aid class and Ithought I've never heard of this
before.
So I go to this class.
It was a full day course andwhat I loved about it because I
(27:09):
went in thinking, just like youmentioned, oh, this is going to
be about awareness, mentalhealth awareness, but what it
really was was a how to foraddressing mental health with
your employees, with people inyour family, with friends, but
how to have those conversations.
And I think it's one of thereasons why we talk a lot about
awareness but not action isbecause we don't know how to
(27:30):
start the conversation and we'reuncomfortable with like, well,
what do I say anything?
Are they going to get offendedif I asked?
And am I going to be morehelpful?
Or is this unhelpful?
Or what if I say the wrongthing?
So we get so stuck in our ownheads that we end up saying
nothing and that's the problemand this course really outlined.
Here's exactly what you say,here's scripting, here's how you
(27:51):
approach it.
Here are, you know, some mythsand what may be holding you back
, and here's what's beneficialand here are the resources
available.
So if somebody is struggling,you understand, okay.
Is it depression, anxiety andeating disorder?
Is it, you know, suicide risk,all these different things?
And that's what I love aboutthe course is it goes through a
variety of different mentalhealth diagnoses and you don't
(28:13):
have to be a clinician to do it.
It's just the awareness of thediagnosis itself, but then the
action plan for you as anindividual in terms of how you
approach, because it is still afirst aid model.
So it's what you can do to givesomebody support before they
get additional professional help.
And it's important to make thedistinction of.
You can have a lot of peoplewho have a mental health
(28:33):
challenge.
That's not the same thing as adiagnosis or a disorder, right?
So it starts with the challengeand if we address it at that
level, at the first day level,when we see those behaviors,
those emotions and we identifythose, then it helps support
somebody so that maybe itdoesn't progress.
But you have to start withbeing comfortable with the
conversation and part of that isknowing what to say.
(28:56):
And that's what I love aboutthis course is it tells people
here's what you can say, here'swhat's helpful, here's what's
not, here's what you can expectthem to, how they might respond
when you say that, and it reallygives you the how to and the
action item.
Because right now, the reasonwe don't have the conversations
isn't because we don't have thedesire to help, we just don't
know how.
We don't have that confidencelevel yet.
So I took the course 10 yearsago and I would always.
(29:17):
It really changed the way Iinteracted with my employees and
whenever I would talk tosomebody about it, I was always
surprised that nobody had heardof this before and it's been
around for 20 something years.
So it's not new, but I thought,well, I'll just get certified to
teach the course becauseeverybody should know about this
.
And in my opinion everybodyshould know about this course.
If I'm still talking about it adecade after I took it, I think
(29:40):
everybody should know about thecourse.
So I think that really doesprovide kind of a foundation for
giving people the tools to knowhow to have these conversations
.
So we're not just talking aboutawareness, we know what to do
when we see those behaviors.
Because in an employersituation, I think the really
unfortunate thing is you havesomebody who has a mental health
(30:00):
challenge.
It starts that way and then wedon't address it until it
becomes a performance issue,where now we have absenteeism,
we have, you know, poor workproduct and we're addressing it
as a performance issue whenreally it might be a symptom of
a mental health challenge.
And we see signs.
That's the most frustratingpart is people see signs when
(30:20):
it's going that route, butemployers don't address it until
it becomes a performance issueand there are so many ways to
support somebody before it evengets to that point.
Speaker 2 (30:29):
And I would imagine a course like this not only
benefits you in an employeesetting, but it can help you
with your family and your kidstoo, right?
Speaker 3 (30:35):
Yeah, I mean, I use the.
I like to tell people this.
I've taken first aid, CPR, AEDcourses, you know, every two
years to get my license.
Ask me how many times I've everused AED or CPR?
Right, well, thank goodness I'venever used an AED or CPR, you
know, fortunately.
But I use the skills that I'velearned in mental health first
aid every month, every monthwhen I talk to somebody, it's
(30:58):
that kind of the action planthey give you.
I use those skills.
So that's really what I love.
It's not, you're right, it'snot just for employers, it
really is for anybody that youinteract with.
Speaker 2 (31:07):
Yeah, that's awesome.
So you are an incredibly upbeat, positive person and, again,
the reason why we connected wassomething that I had noticed
you'd done on LinkedIn, and yourLinkedIn stuff is so creative
and, and I gotta be honest,sandy, it's not, it's a rarity
in this industry to findsomebody that is so positive for
(31:28):
such a long period of time.
Right, you can start and you'relike ready to go and you're
jazzed, but you know,undoubtedly people will start to
get that jaded feeling asthey're, as they're doing what
they're doing here.
How do you keep your positiveattitude and your mental
wellness?
Speaker 3 (31:46):
I think one is being aware of the negativity bias.
I think that really is achallenge in our industry, and
not just in workers' comp, justinsurance in general.
So what happens is you havesomebody who abuses the system.
Right, in any system you'llhave somebody who has a claim
that's fraudulent and thenemployers or adjusters will see
that and it doesn't feel good tobe lied to and they think like,
(32:07):
oh well, I'm not going to letthat happen to me again.
And then you end up paintingeverybody with that brush where
everybody's trying to cheat you,everybody's trying to lie,
nobody wants to go back to work,they're getting attorneys just
because they want money.
And that's the negativity biasbecause realistically, that is a
(32:30):
tiny, tiny portion of yourclaims.
And once I switch that mindsetof understanding that it really
is the formula of looking at howmany employees are in an
employer right and how many ofthose have claims, and how many
of those are those claims thatare, you know, the red flags
that you're thinking of, wherethere's abuse in the system,
it's such a small percentage.
I like to tell employers.
I want you to think of all ofyour medical only claims that
(32:50):
you never talk about at theclaim review because they're
medical only, that you neverreally think of, they're out of
sight, out of mind.
Those are your success storiesthat you never really think of,
they're out of sight, out ofmind.
Those are your success stories.
And that's probably a good halfof all the reported claims.
So, just keeping in mind thatsometimes the jadedness comes
from that negativity bias ofthinking, this is the industry
where you know there's a lot offraud and a lot of abuse, and
(33:13):
not that it doesn't occur.
But it's just important toremember that really is a small
component and absolutely weaddress it and attack it when we
find it.
But that's not your workforce,it's not the majority of injured
workers.
And just remembering that thatthere really is so much, a lot
of people want to go back towork.
I see it all the time with theschools that we work with.
When you talk to people, theywant to go back to work, they
(33:43):
want to be in the classroom,they miss their kids.
So it's remembering thosepositive experiences that really
, unfortunately, it takes suchan effort to focus more on the
positive than the negative,because we naturally want to be
aware of the negative, becausewe don't want to feel that
somebody has lied to us ormisled us, but it's just making
sure that you have that mindsetwhere you're focusing just as
much in the positive, you'relooking at everything
holistically and not just thebad things that happen.
So that's what I try to do.
(34:04):
I try to remember that there'sso much good in the system.
There's a lot of great peoplewho you know are medical only
claims.
They got hurt but they gottheir treatment.
They're back to work full duty.
That's the success story.
Speaker 2 (34:18):
Right and it's.
You know, most of us in thisindustry haven't been injured
workers and so sometimes I feellike it's kind of like a not an
us against them, but it's almosttribal Right.
And and I actually heard at aconference one time a statistic
that said that only 20% of thefraud in workers' compensation
is done by the injured worker.
The other 80% is done byinsurance companies and
(34:41):
employers.
So when we're at a conferenceand we're laughing at the videos
that the investigator took ofthe person who says they have a
back injury and they're throwingtheir kid up in the air, right,
you got to remember that thatis not the majority of the
injured workers out there and Iagree with you 100% In my
experience, most people trulyjust want to get back to work,
(35:03):
they want to get done with whatthey're going through, they want
to get better and they want tobe productive people.
And I think you're absolutelyright.
Just keep that mindset andremember that it's a very, very
small amount that are actuallytrying to do something outside
of what they should be.
Is is not the case in the case,in most cases.
So for mental health first aid,if somebody is interested in
(35:26):
the course or learning aboutthat.
How can they find you?
Speaker 3 (35:31):
They can connect with me on LinkedIn.
I'm very active on LinkedIn.
I check my messages so they cansend me a message.
Feel free to connect with me.
I accept all connectionsbecause I love to connect with
folks in our industry.
So, sandy Avena, mba atLinkedIn and let me know if
you're interested in the courses.
I work with organizations, butI also will try to set up
(35:53):
courses.
If individuals are interestedin taking it, I'll set something
up on on a weekend, a Saturday,where they can go through the
course.
Speaker 2 (35:59):
Well, happy World Kindness Day.
That's why you're here, and Ithink everything you talked
about fits right in super, superwell.
So, sandy, thank you so muchfor your time today.
It's been really a pleasuretalking to you, and I'm going to
keep watching you on LinkedIn,because it's actually one of the
joys of my morning is to seewhat you're posting.
You're doing great stuff, sothank you so much.
Speaker 3 (36:19):
Thanks, todd, thanks for having me.
Speaker 1 (36:20):
World Kindness Day is an international observance on
13th of November.
It was introduced in 1998 bythe World Kindness Movement, a
coalition of nations kindnessNGOs.
It is observed in manycountries, including Canada,
australia, nigeria and theUnited Arab Emirates.
Speaker 2 (36:38):
Thanks for listening to REA Audio.
Please make sure to follow uson Spotify or Apple Podcasts or
Stitcher or wherever you getyour podcasts.
We appreciate you.
Have a great rest of your week.
We'll see you next time.
Perspective.
Perspective is spelledP-E-R-S-P-E-C-T-I-V-E.
Perspective the 30,000 footview.
Perspective put on someoneelse's shoes.
Perspective can also refer tothe state of existing in space
(00:20):
or one's view of the world.
Perspective R-E-A audio.
Speaker 2 (00:30):
Reemployability.
What is the kindest thing thatyou've done for someone this
week?
Think really hard.
Was it for a friend or a familymember, Someone at work, Maybe
a stranger?
And we all know what kindnessis.
But what we experience in ourhearts as a kind act is relative
and depends a lot on context,and sometimes it actually feels
(00:50):
better to do the kindness thanit feels to have the kindness
done to us.
Look, I love my mother-in-lawTruly.
She's a giving, caring,selfless person, but what she
perceives as kindness sometimesis overwhelmingly overbearing.
She'll take on projects and dothings even when she's asked not
to, and it comes from her heartbut isn't always necessarily
(01:12):
regarded as kindness.
Now, on the other hand, thereare times when I could be kinder
or even just do something kindand choose not to.
Have you ever been in a mood andnot let somebody merge in front
of you on the highway or maybenot paid as close attention to
your kids as you should have?
Kindness is defined as thequality of being friendly,
generous and considerate, andNovember 13th is celebrated as
(01:35):
World Kindness Day, a globalobservance dedicated to
promoting and celebrating actsof kindness.
So we thought we'd take thisopportunity to help put kindness
into a different context whenit comes to dealing with all the
players in the workers' compgame, no matter what position or
role you're in.
Sandy Avena is the ClaimsService Manager at California
(01:56):
Schools JPA and a super creativefrequent poster on LinkedIn.
The perspectives and approachshe takes at California Schools
JPA utilizes small, simple bitsof kindness to make tremendously
powerful impacts in the livesshe and her team interact with.
Speaker 1 (02:13):
Kind means generous, helpful and thinking about other
people's feelings.
Speaker 2 (02:17):
California Schools JPA.
Tell us what that is and howdid you get involved with it.
Tell us what that is and howdid you get involved with it.
Speaker 3 (02:24):
So in California they allow public entities to come
together to form a uniqueindividual legal entity for the
purpose of purchasing insurance.
And that's what a JPA is.
It's a joint powers authority.
So you'll see that a lot withcities and counties and school
districts where we come togetherand we form a JPA, and that's
what California Schools JPA is.
(02:44):
So clearly we care to publicschool districts and community
colleges and our JPA is uniquebecause we actually have two
JPAs under our umbrella.
So one of them is for employeebenefits, that type of insurance
, and the other side is for riskmanagement.
So your workers' comp, yourproperty and liability, and I've
been here for five years nowand just really excited to be
(03:04):
part of this risk pool thatserves school districts and get
to work with educators and thefolks who are in charge of, you
know, educating the nextgeneration.
Speaker 2 (03:14):
Well, and what you do .
You take a little bit differentapproach with your injured
workers, as we were kind oftalking about before we came on,
and I think you know.
I want to also preface thereason, sandy, why I had
actually asked you to come onthe podcast.
You are very active on LinkedInand you had made a post that
(03:34):
really caught my attention withregards to an article that you
wrote in Blue Magazine aboutcompassion fatigue in the
insurance world, and you knowREA Audio.
We always try to focus on theinjured worker as a human being,
not just a number on aspreadsheet.
And when you talked about, youknow, adjusters and what
(03:56):
compassion fatigue is, and we'lltalk about that in a little bit
.
You know I'm guilty of notalways thinking that way about
the adjuster, right, I'm alwaysthinking about injured worker
and how can, what can adjustersdo to be better in tune with
injured workers, but we forgetabout the other side of things
and the constant pressure andthings that adjusters and folks
(04:21):
on the insurance end you knowhave to deal with.
And, like I said, we'll talkabout that in a few minutes and
how you're addressing that,which is really important.
But what you're all doingcurrently you take a little bit
of a different approach withinjured workers.
I think kind of similar to whatwe do at reemployability, as
far as looking at them as like ahuman being right.
Speaker 3 (04:42):
Yeah, I think what makes our program unique it's
something we're really proud ofis we formulate everything in
terms of what is best for theemployee experience in workers'
comp.
And a lot of programs.
Look at cost containment.
When you hear about workers'comp programs, the key word is
cost containment.
What are we doing to containcosts?
But cost containment has apoint of diminishing returns.
(05:04):
If you have somebody who'sinjured, your costs are never
going to be zero.
You're always going to havecosts, and sometimes we're
controlling costs that are thesymptom of a poor employee
experience, right.
So litigation can be the resultof a poor employee experience
and then that increases yourcosts, so we kind of flip that.
So instead of focusing so muchon the cost containment, we
(05:26):
focus on what can we do to makesure that the injured worker
knows that they are valued, thatwe care about them, that we
want to make sure that they arereceiving quality treatment,
that they receive it timely,that we are helping them
navigate this process and we'reestablishing that trust with
them, and that, in turn, isgoing to end up controlling your
costs, because they're lesslikely to get an attorney
(05:47):
because they're returning to theworkforce sooner.
So a lot of the design of ourprogram comes from what is the
experience like for the employee, and part of that is the
adjuster right, so it's theyhave to build that relationship
with the employee.
And when I was an adjuster, Iremember what it was like to be
in that world.
It can be a very thankless job.
It can be a job where you havevery high caseloads and that
(06:10):
diminishes your ability to carefor somebody appropriately right
Because you're barely able totake care of yourself.
It is exhausting and you reachburnout.
And a lot of adjusters who dobecome jaded.
It's not that they don't care,it's a method of protecting
themselves.
And so nobody should be in thatsituation where we're just like
(06:31):
in survival mode to get throughthe day because that's a poor
that ends up being a poor resultfor the injured worker.
So for adjusters, in ourprogram we cap the cases at 125.
It's in our contract with ourTPAs and we want that low
caseload because we want theadjusters to have time to
develop that relationship withthe employees, to build that
trust.
(06:51):
And then that in turn means thatthey have less litigation.
So our litigation rate for thelast four years has been between
two and four percent.
Super proud of that because inCalifornia the average according
to WCIRB, they're thestatistical insurance agent, the
statistical agent for workerscomp.
In California, 11 percent isthe average.
Speaker 1 (07:13):
Wow.
Speaker 3 (07:14):
Significantly lower than the average in California
and that really goes to showwhen you focus on employee
experience you bring down yourlitigation.
That brings down your overallcost, so that focusing on the
employee first really does havea great ROI.
Speaker 2 (07:28):
So my, my wife is a teacher.
We're in Florida so obviouslythe setup for the teaching may
be different from state to state, from county to county.
(07:50):
However you have it set up, Ibelieve people who get into
teaching get into it.
For most of the time it'sreally really good reasons and I
think teachers can get jaded aswell, right?
So it's important to kind oflook at them and look at them
with some a little bit of adifferent perspective, I think,
than some other folks, not totreat them any differently, but
just understand.
(08:11):
I think you know there's acertain mentality that gets you
into teaching and when thosepeople are injured on the job or
even other folks in theeducation system, I think that
different approach certainlyhelps to get them recovered
faster.
Now is what you're doing withCalifornia Schools, jpa, and the
approach you're taking.
(08:31):
Is that unique to yourorganization, like in all your
previous experience in workers'comp and insurance?
Is this a different approachthan what you're used to?
Speaker 3 (08:43):
Oh, very much so.
So I have experience on the TPAside and I have experience on
the insurer side.
And on the insurance side youreally are looking at cost
containment because you have tostay solvent.
But for a risk pool, our focusis the employer and that's
something that not that the TPAsand carriers don't consider,
(09:04):
but that's not top of mind forthem.
For us, we want the employer tohave a good relationship with
their employee.
That's the difference of therisk for employer focus.
So we're looking at not justwhat can we do to contain costs
for claims, but how does thisrelationship carry on after the
claim is over?
Right, and that goes back tothat employee experience,
(09:25):
because experience is going tocompound positively or
negatively.
So if they have a badexperience, they're telling
everybody, they're tellingeverybody, they're telling their
co-workers they're putting areview on Glassdoor.
They're going to be on LinkedIn,but if they have a positive
experience, that compounds too.
So that's the different focusis we want them to have a good
relationship with their employer, because at some point they
(09:46):
have to go back to the workforceand we want to reinforce that
positive culture.
So that's really important tous in a way that you don't
necessarily see that focus withinsurers or TPAs.
And that is the beauty of JPAsand risk pools, because you have
that ability to be morecreative in designing your
program that is more focused onthe employer and the
relationship with theiremployees.
Speaker 2 (10:07):
So, practically, can you tell us some of the things,
some of the actionable thingsthat you do to help improve that
relationship?
Speaker 3 (10:13):
Absolutely so.
On top of the case low cap wehave a pass through program for
utilization review.
So in California we have autilization review process where
treatment has to go through URto determine whether or not it's
appropriate.
But there's a very low level ofauthority that the labor code
allows the adjuster to authorizeat their desk level.
Because we're a risk pool andwe have flexibility, we allow
(10:34):
the adjusters to authorize muchmore treatment than what's
outlined in the labor code.
And the purpose of that is Idon't want the employee waiting
for something to go throughutilization review, to wait for
it to be reviewed, to get theapproval letter, and delay the
care.
When it's somethingconservative, like physical
therapy, over-the-countermedications, those are the sorts
of things that the adjustershould be able to do at their
level to get the employee careas quick as possible.
(10:56):
So we let the adjustersauthorize a lot more at the desk
level and we also listen to ouradjuster's suggestions.
So if they say, hey, this wasdenied by utilization review,
but I think it should beoverturned and here's why why we
have the low case, low cap, sothat they can develop the
relationship and they can say,hey, I built this relationship
with this employee.
I think if we just get thisadditional chiropractic
treatment, I think this is goingto be good and we're going to
get them to MMI and we're goingto be able to resolve the case.
(11:19):
Great, let's do it.
So we're looking at what can wedo to make sure that we build
in that relationship.
We trust the adjuster to getthe employee the care that they
need.
We also have a greatoccupational management program,
occupational clinic managementprogram, and we'll go down to
(11:39):
the clinics.
We develop relationships withthe operations manager at the
clinic.
We talk about things like waittimes, about the timeliness of
reporting, about ambiguity withwork restrictions.
That's a big one.
So if a doctor writes a workrestriction that says no heavy
work, that ends up creating alot of issues with the employer
and the employee because we mayhave very different ideas about
what heavy work means right andthen the employee's like, well,
that's not what I think it meansand that breakdown in trust
(12:00):
starts.
So making sure that there'sclarity from that from the
get-go, so that it creates aeasier interactive process for
the ADA, so the employer canbring them back and everybody
knows okay, no lifting with yourright arm over 10 pounds.
We all know what that means andthat makes it easier.
So making sure that we havethose relationships and we fix
those problems at the root issue.
(12:21):
And then we also have a managertraining, because I've seen in
the past, in my past experience,a lot of employers will go
radio silent on an employee oncethey're off work, for whatever
reason it's either.
They well, they're off work, Idon't have to talk to them at
all and it's really confusingfor the employee because they
often think they're beingpunished.
I haven't heard anything frommy employer, nobody's reached
(12:44):
out to me.
And then sometimes there'sconfusion because they'll call
the adjuster about things theemployer sends.
Well, I got FMLA paperwork.
What does this mean?
So it's just making sure thatthe managers understand hey, you
can still keep in contact withyour employees, you can still
say, hey, like hope, you'regetting better.
Let them know that you don'thave to ask for a diagnosis, but
you can still have a humanconnection with somebody and
(13:06):
facilitate that return to workprocess, because the employees
don't know that they're wantedback, that's the key is we want
to make sure that they know wewant them back, they're not
being punished for having aninjury.
We don't think that they're lessthan than having an injury.
And then the last two itemswere really specific to our
program.
One is a get Well Card contest.
So for our school districts wehave a contest periodically
(13:27):
where the students all submittheir artwork and then some
winners are selected.
The winners get gift cards andthen we take that winning
artwork and we turn it into GetWell Cards and then we give
those to our districts to giveout to employees when they're
off work.
So it's just a nice touch toget something in the mail.
It's not just to get well cardbut also get well card that was
made by the kids in yourdistrict that you work for.
So it's a super awesome program.
(13:48):
It's something that I don'tthink I've ever seen before in
my prior experience outside ofthe JPA.
And then the most recentaddition we've had is a
partnership with Kind SoulsFoundation, and I don't know if
you're familiar with Kind Souls.
Speaker 2 (14:00):
Oh yeah, very much, Great, great organization.
Speaker 3 (14:03):
Yeah, we were really excited to partner with them
because I think that really is amissing gap in the claims
process is there's statutorybenefits under workers comp, but
sometimes somebody who has adisability has needs outside of
what workers comp can provide.
But it's less than I normallymake and I'm having trouble, you
(14:23):
know, being able to cover basicnecessities.
I'm having trouble affordingfood or maybe I need affordable
child care.
Workers can't really help withany of that, but kind souls can
they give you those resources.
But they also follow up withthe employee and that's the
component I love.
It's not just the 800 numberwhere you call and you say, well
, do you have resources?
In my area they're following upto say, hey, how did that go?
(14:46):
Did you use the resources?
Did that work out for you?
They're looking for thatfeedback and then they follow up
again.
So it's just I wish I wouldhave had that as a resource when
I was an adjuster for employeeswho are struggling, because you
do have people who reallystruggle financially as a result
of their disability.
Yeah, of course, and workersworkers comp doesn't cover
everything.
It covers a statutory benefit.
So it is a great way to againcreate a better employee
(15:09):
experience, provide them alittle extra outside of the
workers comp through theseadditional resources, and so all
of those are steps that we havein parts of our program that
again reinforce what are wedoing to take care of the
employee.
No-transcript.
Speaker 2 (15:30):
As part of my role at re-employability, I get to
travel around and speak with ourclients, but while I'm on the
road I always make sure to visitthe nonprofits that are our
partners.
No matter where I am, there'salways a nonprofit and many
times they will have injuredworkers that have been placed
there through our program.
Too many times when I'll talkwith the injured worker I'll
hear a story like you know, wegot the job offer letter in the
(15:53):
mail and I showed up here and Ireally didn't know what to
expect.
It's because the employer isafraid, and I think that's
really what it is.
It comes down to fearno-transcript, but but employers
(16:28):
are afraid to position it thatway and talk to them about it,
and so they just kind of punt itover to us and let us send out
the offer letter and hope thatthe injured worker shows up.
And it is.
It's really sad and you knowit's the little things that
you've mentioned in everythingthat you do.
It's not necessarily earthshattering, world changing
things that you're doing.
You're sending out cards topeople you know I mean seriously
(16:48):
Kind Souls Foundation.
What tell me about the level ofrelationship?
Like, what do you do?
Do you just let them know thatit's available, or how does that
work?
Speaker 3 (16:58):
So for Kind Souls Foundation we have a flyer that
goes into the new loss packetthat the employers hand out,
right?
So once the employee files theinjury, the employee gets a new
loss packet and it'll have aflyer in there with information
and so that way they know it'savailable there.
But we also let our TPAs knowthat we're partnering with them
so that if the adjuster istalking to the injured worker
(17:18):
and they mention something, theycan make sure that they use
that as a resource.
Yeah, and we've also made surethat the HR teams with our
employers know that this isavailable.
Because what I love about KindSouls is this fits into work
perfectly because they reallyservice anybody who's had a work
displacing event.
But that could be anythingoutside of Workers' Comp, right?
Somebody could be on FMLA, formaybe they're a caregiver, maybe
(17:41):
they are on Workers' Comp for anon-industrial condition, so
anything that really is a workdisplacing event.
They can access Kinesals.
So we tell our HR teams this ispart of our Work Comp program,
but by all means make sureeverybody knows that this is a
resource.
And we even had someconversations recently with our
districts who said you know what?
This might actually be?
(18:02):
A great parent resource.
Some of our districts haveparent resource Web site pages
where they can make sure thatyou know this affects parents
too.
Some parents may have a workersplacing event, so really just
spreading that word because itreally supports not just the
injured workers but theemployees of the district.
The parents of the studentsthat attend Just really excited
about the applicability of thisservice to everyone in the
(18:24):
community.
Speaker 2 (18:25):
It's a matter of just saying something right it's
about knowing the resources thatare available and telling
somebody about it.
You know this is I hope thisdoesn't come across as goofy it
I hope this doesn't come acrossas goofy, but I had an epiphany
one time when somebody told methat it was okay to give
somebody a compliment.
You walk by somebody in theoffice and you're like, hey,
your shoes look nice today.
(18:46):
A lot of times I would justthink it and not say it.
You have no idea how justsmiling at somebody passing them
in the hallway or making a kindcomment that maybe you thought
but didn't want to say, or forwhatever reason, just didn't say
, say it, give peoplecompliments, smile to people.
You have no idea how that'sgoing to impact their lives.
(19:08):
You know, you never know whensomebody is going to need that,
and I think that says a lotabout the way your program is
moving forward with regards tojust those little things that
make huge differences, isobviously translating into great
successes, for what yourorganization is doing.
Is this scalable company?
(19:30):
Do you see this approach beingable to, you know, take over the
industry in a way that mightbenefit others who aren't able
to be a part of yourorganization?
Speaker 3 (19:42):
I think it absolutely can, but it needs to come from
the employer level, as opposedto the TPA and the insurer,
because at the end of the day,this has to fit in with the
employer's value system, right?
So if you have a TPA or carrierwho says, hey, you should
implement this, but theemployer's like, nah, I don't
think we want to do that.
Our managers don't really wantto talk to them once they're off
work.
Then that's the disconnect,that's the problem.
(20:03):
So it really does have tohappen at the employer level,
and then your TPAs and yourcarriers can be partners in that
.
But any organization, I don'tcare who they are your employees
are the greatest asset you have.
So I don't know why anyonewouldn't want to take this
approach.
I think there's an ROI tokindness.
Speaker 1 (20:25):
That's the hill to die on.
Speaker 3 (20:26):
Yeah, there really is , and our program really is
evidence of that, and I hopethat with that success, other
employers will see that and say,oh, we might be able to do this
at our level as well, and if wetake care of our employees,
we're going to see that costcontainment just as a result of
that, as opposed to making costcontainment the central focus
(20:48):
and not really looking at theemployee experience.
Speaker 2 (20:50):
Have you faced any hurdles within the organization
in implementing any of thesethings?
Speaker 3 (20:54):
Have you faced any hurdles within the organization
in implementing any of thesethings?
I think not within theorganization, but just
explaining to people, the ROI.
So in a very metrics-drivenworld, which insurance is,
sometimes it can be difficult toexplain.
Here's how we're going toreduce costs by focusing on
employee experience, becausepeople are used to looking at
(21:15):
specific metrics and we see thatas the result.
But in the beginning these aresoft benefits that it can be
sometimes difficult to measureand project.
But we have really great schooldistrict members.
We have a fantastic board whoabsolutely believes in taking
care of their employees, becausethey know that their employees
are the ones taking care of thekids in our community.
(21:36):
So, they are all in with it, soit's just making sure that they
understand the benefit, but whenwe bring these benefits forward
they usually are all in becausethey know that's going to
create a better relationshipbetween the district and their
employees.
Speaker 2 (21:48):
So, with the folks that work and take this approach
, you know again, going back tothat article that you wrote in
Bloom about compassion, fatigue,talk a little bit about how
this approach helps folks on theadjuster side who are taking on
these, I guess, additionalresponsibilities.
To be nice.
I mean, I hate to say it, butwhen you get into that mindset
(22:10):
of checking the boxes becauseI'm overloaded and I just have
to get through this one to getto the next one, you are asking
people to pause, step back andkind of reevaluate their
approach.
Do you see that that helps themental wellness of the people
that are actually taking theapproach, those adjusters?
Speaker 3 (22:28):
I think it does, because it's making sure the
adjusters understand the benefitthat they provide and that this
really is about communityservice.
So some adjusters and again itdepends on the account that
you're tied to, because someaccounts have a very different
approach Some accounts are notcommunity-minded, they're not
(22:49):
focused on employee experienceI've worked with challenging
accounts in the past.
Experience they can be.
You know, I've worked withchallenging accounts in the past
and that can really be verydefeating as an adjuster because
it makes it difficult for youto really help somebody If you
know that the employer is notengaging in the interactive
process, they're not acting ingood faith and that can be
(23:12):
stressful because you want to beable to help.
But if you have a client who isnot community minded and they
don't want to help or saythey're just going to control
their costs, that becomesstressful.
That really feeds into thatburnout and that compassion
fatigue because you feel likeyou're steering the ship by
yourself.
You're trying to help thisemployee but you know that
they're not getting any help onthe employer's side or there's
no resources for them outside ofjust the workers' comp benefits
(23:36):
.
So in the Bloom article I talkedabout my own experience of you
know somebody who had a reallycatastrophic injury and the
employee's wife had called andshe was just struggling just
with what this meant for her andher family.
The employee had beenhospitalized for several months
and I really it just hurt myheart because I felt like I had
(24:00):
nothing else to give her outsideof statutory benefits.
And when we designed thisprogram that really is the goal
is for adjusters to know thereare other things you can offer
the employees outside of justthe statutory benefits, and
that's the resources that theemployer partners with so Kind
Soul Foundation, the Get Wellcard, making sure that the
employee feels supported, andthat way it's not the adjuster
(24:23):
carrying that load, becausethat's a lot to put on the
adjuster.
If the employee is getting nocommunication from the employer,
then who's getting the callsfor the insecurity and the fear
and the anxiety that theemployee has?
Speaker 2 (24:34):
The adjuster is.
Speaker 3 (24:36):
And we don't know how to answer those questions if
there's no communication fromthe employer.
So it puts the adjuster in areally bad spot when there's no
communication from the employer.
Or, even worse, there's badcommunication from the employer,
where the employer is makingcomments like oh, you know, must
be nice to have a paid vacationor, you know, we're all having
to work harder because you'regone and we all had to pick up
(24:57):
your slack.
That makes the employee feelworse and then they call the
adjuster because they don'ttrust the employer.
So that just puts thatadditional burden on the
adjuster and that againcontributes to that burnout.
So I think that really is.
The difference here is we'retrying to create a positive
environment.
So it's not the adjuster justgetting the call, where they're
being dumped on for everythingor because they're the only one
(25:18):
who's communicating with theemployee.
They are now just the personwho gets the blame for the lack
of communication with theemployer.
You know, for their poor medicalexperience.
With medical care, the adjustergets blamed for things that are
outside of their control, right.
Speaker 1 (25:34):
Yeah so that's.
Speaker 3 (25:35):
I think that really does help.
If you have a program that isfocused on employee experience,
on a positive employeeexperience, it just creates a an
environment where the adjusterreally is able to focus on
relationship building with thatemployee, as opposed to it being
purely negative.
Speaker 2 (25:53):
So all these things we talk about really relate to
mental wellness and mentalhealth, and that's a big
buzzword now.
Everybody talks about mentalwellness and you even talked
about it in your post onLinkedIn today about you know,
it's a trendy.
You didn't say trendy, I'msaying trendy, but it's a trendy
thing to talk about andeverybody's quote-unquote aware
(26:15):
of it.
But what actions can peopletake to improve that mental
wellness?
Because, as an injured worker,you need to be able to take
those steps.
As an adjuster, you need to beable to take those steps, and it
sounds like there's a lot ofemployers that need to take that
step as well, because, at theend of the day, if we're all
just in better mental fitness orbetter shape, we're going to be
(26:37):
better people to each other.
So talk a little bit aboutmental wellness and some of
those actions you can take.
And then mental health firstaid, which is really really
interesting.
Speaker 3 (26:47):
So I'll start with a little story about how I found
out about mental health firstaid.
I worked for an employer, ahealth plan about 10 years ago.
They sent all the managers to aclass and it was a mental
health first aid class and Ithought I've never heard of this
before.
So I go to this class.
It was a full day course andwhat I loved about it because I
(27:09):
went in thinking, just like youmentioned, oh, this is going to
be about awareness, mentalhealth awareness, but what it
really was was a how to foraddressing mental health with
your employees, with people inyour family, with friends, but
how to have those conversations.
And I think it's one of thereasons why we talk a lot about
awareness but not action isbecause we don't know how to
(27:30):
start the conversation and we'reuncomfortable with like, well,
what do I say anything?
Are they going to get offendedif I asked?
And am I going to be morehelpful?
Or is this unhelpful?
Or what if I say the wrongthing?
So we get so stuck in our ownheads that we end up saying
nothing and that's the problemand this course really outlined.
Here's exactly what you say,here's scripting, here's how you
(27:51):
approach it.
Here are, you know, some mythsand what may be holding you back
, and here's what's beneficialand here are the resources
available.
So if somebody is struggling,you understand, okay.
Is it depression, anxiety andeating disorder?
Is it, you know, suicide risk,all these different things?
And that's what I love aboutthe course is it goes through a
variety of different mentalhealth diagnoses and you don't
(28:13):
have to be a clinician to do it.
It's just the awareness of thediagnosis itself, but then the
action plan for you as anindividual in terms of how you
approach, because it is still afirst aid model.
So it's what you can do to givesomebody support before they
get additional professional help.
And it's important to make thedistinction of.
You can have a lot of peoplewho have a mental health
(28:33):
challenge.
That's not the same thing as adiagnosis or a disorder, right?
So it starts with the challengeand if we address it at that
level, at the first day level,when we see those behaviors,
those emotions and we identifythose, then it helps support
somebody so that maybe itdoesn't progress.
But you have to start withbeing comfortable with the
conversation and part of that isknowing what to say.
(28:56):
And that's what I love aboutthis course is it tells people
here's what you can say, here'swhat's helpful, here's what's
not, here's what you can expectthem to, how they might respond
when you say that, and it reallygives you the how to and the
action item.
Because right now, the reasonwe don't have the conversations
isn't because we don't have thedesire to help, we just don't
know how.
We don't have that confidencelevel yet.
So I took the course 10 yearsago and I would always.
(29:17):
It really changed the way Iinteracted with my employees and
whenever I would talk tosomebody about it, I was always
surprised that nobody had heardof this before and it's been
around for 20 something years.
So it's not new, but I thought,well, I'll just get certified to
teach the course becauseeverybody should know about this
.
And in my opinion everybodyshould know about this course.
If I'm still talking about it adecade after I took it, I think
(29:40):
everybody should know about thecourse.
So I think that really doesprovide kind of a foundation for
giving people the tools to knowhow to have these conversations
.
So we're not just talking aboutawareness, we know what to do
when we see those behaviors.
Because in an employersituation, I think the really
unfortunate thing is you havesomebody who has a mental health
(30:00):
challenge.
It starts that way and then wedon't address it until it
becomes a performance issue,where now we have absenteeism,
we have, you know, poor workproduct and we're addressing it
as a performance issue whenreally it might be a symptom of
a mental health challenge.
And we see signs.
That's the most frustratingpart is people see signs when
(30:20):
it's going that route, butemployers don't address it until
it becomes a performance issueand there are so many ways to
support somebody before it evengets to that point.
Speaker 2 (30:29):
And I would imagine a course like this not only
benefits you in an employeesetting, but it can help you
with your family and your kidstoo, right?
Speaker 3 (30:35):
Yeah, I mean, I use the.
I like to tell people this.
I've taken first aid, CPR, AEDcourses, you know, every two
years to get my license.
Ask me how many times I've everused AED or CPR?
Right, well, thank goodness I'venever used an AED or CPR, you
know, fortunately.
But I use the skills that I'velearned in mental health first
aid every month, every monthwhen I talk to somebody, it's
(30:58):
that kind of the action planthey give you.
I use those skills.
So that's really what I love.
It's not, you're right, it'snot just for employers, it
really is for anybody that youinteract with.
Speaker 2 (31:07):
Yeah, that's awesome.
So you are an incredibly upbeat, positive person and, again,
the reason why we connected wassomething that I had noticed
you'd done on LinkedIn, and yourLinkedIn stuff is so creative
and, and I gotta be honest,sandy, it's not, it's a rarity
in this industry to findsomebody that is so positive for
(31:28):
such a long period of time.
Right, you can start and you'relike ready to go and you're
jazzed, but you know,undoubtedly people will start to
get that jaded feeling asthey're, as they're doing what
they're doing here.
How do you keep your positiveattitude and your mental
wellness?
Speaker 3 (31:46):
I think one is being aware of the negativity bias.
I think that really is achallenge in our industry, and
not just in workers' comp, justinsurance in general.
So what happens is you havesomebody who abuses the system.
Right, in any system you'llhave somebody who has a claim
that's fraudulent and thenemployers or adjusters will see
that and it doesn't feel good tobe lied to and they think like,
(32:07):
oh well, I'm not going to letthat happen to me again.
And then you end up paintingeverybody with that brush where
everybody's trying to cheat you,everybody's trying to lie,
nobody wants to go back to work,they're getting attorneys just
because they want money.
And that's the negativity biasbecause realistically, that is a
(32:30):
tiny, tiny portion of yourclaims.
And once I switch that mindsetof understanding that it really
is the formula of looking at howmany employees are in an
employer right and how many ofthose have claims, and how many
of those are those claims thatare, you know, the red flags
that you're thinking of, wherethere's abuse in the system,
it's such a small percentage.
I like to tell employers.
I want you to think of all ofyour medical only claims that
(32:50):
you never talk about at theclaim review because they're
medical only, that you neverreally think of, they're out of
sight, out of mind.
Those are your success storiesthat you never really think of,
they're out of sight, out ofmind.
Those are your success stories.
And that's probably a good halfof all the reported claims.
So, just keeping in mind thatsometimes the jadedness comes
from that negativity bias ofthinking, this is the industry
where you know there's a lot offraud and a lot of abuse, and
(33:13):
not that it doesn't occur.
But it's just important toremember that really is a small
component and absolutely weaddress it and attack it when we
find it.
But that's not your workforce,it's not the majority of injured
workers.
And just remembering that thatthere really is so much, a lot
of people want to go back towork.
I see it all the time with theschools that we work with.
When you talk to people, theywant to go back to work, they
(33:43):
want to be in the classroom,they miss their kids.
So it's remembering thosepositive experiences that really
, unfortunately, it takes suchan effort to focus more on the
positive than the negative,because we naturally want to be
aware of the negative, becausewe don't want to feel that
somebody has lied to us ormisled us, but it's just making
sure that you have that mindsetwhere you're focusing just as
much in the positive, you'relooking at everything
holistically and not just thebad things that happen.
So that's what I try to do.
(34:04):
I try to remember that there'sso much good in the system.
There's a lot of great peoplewho you know are medical only
claims.
They got hurt but they gottheir treatment.
They're back to work full duty.
That's the success story.
Speaker 2 (34:18):
Right and it's.
You know, most of us in thisindustry haven't been injured
workers and so sometimes I feellike it's kind of like a not an
us against them, but it's almosttribal Right.
And and I actually heard at aconference one time a statistic
that said that only 20% of thefraud in workers' compensation
is done by the injured worker.
The other 80% is done byinsurance companies and
(34:41):
employers.
So when we're at a conferenceand we're laughing at the videos
that the investigator took ofthe person who says they have a
back injury and they're throwingtheir kid up in the air, right,
you got to remember that thatis not the majority of the
injured workers out there and Iagree with you 100% In my
experience, most people trulyjust want to get back to work,
(35:03):
they want to get done with whatthey're going through, they want
to get better and they want tobe productive people.
And I think you're absolutelyright.
Just keep that mindset andremember that it's a very, very
small amount that are actuallytrying to do something outside
of what they should be.
Is is not the case in the case,in most cases.
So for mental health first aid,if somebody is interested in
(35:26):
the course or learning aboutthat.
How can they find you?
Speaker 3 (35:31):
They can connect with me on LinkedIn.
I'm very active on LinkedIn.
I check my messages so they cansend me a message.
Feel free to connect with me.
I accept all connectionsbecause I love to connect with
folks in our industry.
So, sandy Avena, mba atLinkedIn and let me know if
you're interested in the courses.
I work with organizations, butI also will try to set up
(35:53):
courses.
If individuals are interestedin taking it, I'll set something
up on on a weekend, a Saturday,where they can go through the
course.
Speaker 2 (35:59):
Well, happy World Kindness Day.
That's why you're here, and Ithink everything you talked
about fits right in super, superwell.
So, sandy, thank you so muchfor your time today.
It's been really a pleasuretalking to you, and I'm going to
keep watching you on LinkedIn,because it's actually one of the
joys of my morning is to seewhat you're posting.
You're doing great stuff, sothank you so much.
Speaker 3 (36:19):
Thanks, todd, thanks for having me.
Speaker 1 (36:20):
World Kindness Day is an international observance on
13th of November.
It was introduced in 1998 bythe World Kindness Movement, a
coalition of nations kindnessNGOs.
It is observed in manycountries, including Canada,
australia, nigeria and theUnited Arab Emirates.
Speaker 2 (36:38):
Thanks for listening to REA Audio.
Please make sure to follow uson Spotify or Apple Podcasts or
Stitcher or wherever you getyour podcasts.
We appreciate you.
Have a great rest of your week.
We'll see you next time.
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