S4 E5: Workers’ Comp Unpacked: Navigating Injuries, Communication, and Compliance


Podcast October 31, 2023

We’re jumping into the world of workers’ compensation. We start with an introduction to the topic, emphasizing the role of businesses and HR professionals. As we navigate workers’ compensation, Pete Wright will be joined by Dan Ilnicky of A.I.M. Mutual, an expert in workers’ comp, and our in-house HR specialist, Lori Bourgoin. Together, they will provide insights into the initial steps post-injury, the nuances of communicating with employees on workers’ comp—including those with legal representation, and the pivotal laws that shape these processes. We’ll also discuss the challenges and considerations of reintegrating employees post-injury. Wrapping up, we underscore the importance of proactive management and the value of clear communication and compliance.
Links & Notes

 


Transcript:

Pete Wright:
Welcome to Human Solutions, simplifying HR for people who love HR. From AIM HR Solutions on TruStory FM, I’m Pete Wright.
This week, we’re talking all about injuries. In fact, if I were sitting there next to you as you’re listening to this show and I asked you to name the top Workplace injuries, could you do it? Are you ready for the next injured worker to walk through your door? This week, we’re going to find out. I’m sitting down with an ace in the world of workers’ comp, Dan Ilnicky of A.I.M. Mutual, and our very own HR expert, Lori Bourgoin, and they’re going to tell me when I should grab the logbook or stick with a bandaid and a pat on the back.
Dan and Lori, welcome to Human Solutions. Great to have you here.

Lori Bourgoin:
Thank you, Pete, for having us. Dan, good to see you.

Dan Ilnicky:
Yeah. Thank you, Pete. Lori, nice to see you as well.

Pete Wright:
It is delightful, though our topic may be dare I say injurious. Let’s talk first. Give us an introduction or a table setting on the topic of workers’ comp. From the perspective of our HR pros who are listening to this show, what do we need to know to get started with this conversation?

Lori Bourgoin:
One thing that you mentioned, Pete, is having that injured worker walk through the door. That’s one thing as HR professionals would like to avoid is not having the injured worker walk through the door.

Pete Wright:
Right. Right. That could be a metaphor.

Lori Bourgoin:
Well, I guess what I’m referring to is trying to get to put practices and policies in place and training in place to avoid the injury and being proactive, but one that does happen. Having a great partnership with your workers’ comp carrier like A.I.M. Mutual is invaluable to making sure that the individual is treated well and gets back to work as soon as possible.

Pete Wright:
Well, I think that’s a really great point, and I want to underscore that because, you’re absolutely right, we want to avoid injuries, and yet we are here talking with A.I.M. Mutual because injuries happen on the job and we want to be prepared. Dan, tell us a little bit about workers’ comp and what we need to know and why it’s so important for HR pros to know the process inside and out.

Dan Ilnicky:
Right. Lori’s already teed this up so well. It’s this opportunity really for the employer to establish a relationship with their workers’ compensation carrier before anything even happens. I know one of the things that we do at A.I.M. Mutual is we will actually onboard any new policyholder so they know who they need to contact, when they need to contact, ways and methods of contacting. It’s not just reporting an incident, but it’s establishing that relationship and that partnership with the carrier and the employer so that when something happens, if something happens, that everyone is ready to go and understands what the process is going to be.

Lori Bourgoin:
Also, tracking any workers’ comp case along the lines. I’ve dealt with many, many clients who have unfortunately had employees that got hurt and they haven’t heard or connected with their workers’ comp carrier, they don’t know what’s going on with the employee if and when he or she’s going to return back to work, how they’re doing. That’s really something that we can do better with to have better outcomes. If we can build that relationship with our workers’ comp carrier, whoever is managing the case and stay close to how is this individual doing, as well as us directly as HR people calling employees, “How’s it going? Is there anything that we can do? Are you missing any information? Are you hearing from your doctor?” just can help the case for a better, I keep saying a better outcome, but getting the person back to work as soon as they possibly can.

Dan Ilnicky:
Lori, you bring up some great points. When we hear an injured worker have some conversation with one of our claims adjuster people, one of the first things that comes out of their mouth is that, “We haven’t heard from anybody.” We will often say as a worker’s comp carrier, somebody within an employer’s operation, they go out on maternity leave or they are away for some other purpose or reason. They’ll get cards. They’ll get flowers. They’ll get contact. People will reach out to them, but when an employee becomes injured, it’s like crickets. They aren’t hearing anything. One of the places that you start to lose that connection with that employee is at that point, so be in touch with them.
It’s not just the workers’ comp carrier that needs to do that communication. It’s the employer as well. They’re your employees still. The better relationship you can have, the more communication that can occur will, to your point, Lori, result in a better outcome in the end because they feel like they’re welcome. They feel like they’re wanted back to the employer, so all of that relationship maps as well as the relationship with the workers’ comp carrier. The employee, the employer, typically at the employer, it’s a human resource person, but sometimes it’s a supervisor or manager and then your contact at the workers’ comp carrier, all of those people having conversation and working together, it will result again in a better outcome.

Pete Wright:
I got to jump in because, when I hear this, I hear this absolute, “We’re all on a team.” That’s all great. I love that we’re on a team, and we got to treat people like we’re on a team, but when we’re in workers’ comp, isn’t there a case where your employee who’s out on workers’ comp is going to have legal representation? It adds a layer of complexity that we need to cover. What’s the norm? What is the expectation when, suddenly, you have almost an adversarial relationship with the team?

Lori Bourgoin:
I think it’s a really good point you’re bringing up, Pete. The majority of employers have the best interests of their employees at heart. I think, sometimes, when it comes to workers’ comp, employers are unsure of “what is my role here”? When you think about it, this is your employee. Even if your employee has legal representation, it’s still your employee to check on, talk about what position you may have that could fit for their potential injury in the approval of their physician and that you care about them and you want them to come back. You don’t have to talk about the court case or the legal case. That is secondary to your connection with your employee.

Dan Ilnicky:
Take that a little bit further. It’s not only the connection with the employee piece, but it’s letting them know that they have a place to come back to when they’re better. “Better” can be enough for them to come back with some modified duties, some restrictions that say, “Hey, we know you’re not at a hundred percent yet, but we want you back here. We’re willing to find something for you to do.” It’s a value to the employer as well. It’s not meant to be demeaning to an employee to bring them back. It’s bringing them back with a contribution to what they want to be doing as an organization.
When you look at the whole picture, having a plan ahead of time, being prepared for “what do we do if somebody goes out and is injured”, you’re not focusing on an individual or a person. You’re focusing on what their role and their function and their contributions are going to be, so figure that out. Have that plan ready and work with the understanding within the employee group that, look, if somebody is her injured at work, our expectation is we’re going to try to get you back as soon as possible because we want you back. You’re a value to us.
Letting them know and emphasize that is going to go a long way, and then making sure that the workers’ comp carrier understands that, “Hey, we have alternative duties for the employees if we do have an incident that occurs.” All that communication, again, is going to be a value.

Lori Bourgoin:
Let me piggyback on what Dan had to say in terms of preparation. I think that’s very important. From an HR perspective, a business perspective, having a workers’ comp policy, having a leave-of-absence policy, having the required posters, in Massachusetts, you’re required to have a poster that states who your workers’ comp carrier is, having safety committee meetings, just overall communication on “how do we prevent injuries and what happens when an employee is injured”, it’s important for the direct line supervisors to know, “If I have somebody who is hurt on the job, what do I do? What is my responsibility?” having employees understand what they are responsible for in terms of paying premiums for their health insurance while they’re out or anything like that.
There are also laws that we have to consider when it comes to an employee who’s out on workers’ comp. If you have 50 or more employees, you have the Family Medical Leave Act, and that will, if you have a policy in place, run concurrent with any workers’ comp case. You also have the Americans with Disabilities Act that, if an employee could fall under this classification and when we return them to work or attempt to return them to work, can we provide a reasonable accommodation? There are a lot of arms and legs to it, and being proactive prior to anything happening is really the wisest move for all employers, small or large.

Pete Wright:
Well, I think you’re getting to the point that I wanted to get to, which is addressing the circumstances when employees are not able to return to work in the same function that they were before. You dropped FMLA and Americans with Disabilities. Are there other circumstances that, when you build this communication plan for your employees and say, “Look, we want you to know that we’re supporting you through the entire arc of any potential injury,” and that may include educating them specifically on FMLA or Americans with Disabilities Act?

Lori Bourgoin:
Those are policies that you had in place. It’s a really good point, Pete. Let’s make sure employees know what leave-of-absence policies are applicable to them, how we handle the Americans with Disabilities Act. The other aspect of HR are job descriptions.
Dan, I’m sure you could speak to this as well. A job description will provide the employee as well as their physician with what are the essential duties of this job. What is required? What is required from a physical, a mental, a cognitive ability so that a physician will know, well, this employee cannot return to work to that job. If you have a job description for another position, yes, they can absolutely return. They can come into that position for a short period of time before they return to, potentially, their other position, their regular position.”

Dan Ilnicky:
I wouldn’t be doing the safety profession justice if I don’t make a remark on a comment you just made, and that is if an employee is in a position that they’re subject to injury. One of the things that we work really hard for, and this is that proactive piece, is that nobody should go to work with an anticipation that they might get hurt there. Right? Things do happen. We recognize that, but to be proactive and to do job safety analysis and to identify those things that you can do to be proactive to reduce and eliminate potential for exposures and injuries is of utmost importance of any safety professional and I know many employers even if they don’t have that function within their organization. If you don’t mind, I have to make that comment.

Pete Wright:
No. Absolutely. I’ll tell you, I worked for a time in a Cummins’ diesel engine factory, believe it or not. I’ll tell you, the word from those of us on the floor working under these engines was, “I’m so glad. I’m so relieved we have such a rigorous training operation,” and the reality is there would not be a rigorous training operation if we were not aware that injuries could happen. That serves two motivations. One, it makes us glad we have an employer that cares and, two, it makes us always aware, ever vigilant that things happen. I think it’s a good thing to be aware of that, to be aware that it makes you more careful, doesn’t it?

Dan Ilnicky:
Absolutely. Lori and I talk about these types of scenarios I guess on a regular basis. To your point, we talk about how to make a job position safe for any employee that’s in it, but what happens after an incident does occur, all of your due diligence, every effort that you’ve put in to try to make that as safe as possible, yet we still have an incident? We still have an injury that occurs. We have near misses where an injury doesn’t occur, but something happens and maybe there’s property damage or maybe something didn’t function properly.
One of the things that I look at as an imperative step is to do an accident and incident investigation. Let’s find out what went wrong, what happened, so that we can make our corrective actions so it doesn’t happen again, and obviously part of the goal is so that nobody becomes hurt and injured where we even have to have this process that we’re talking about today.

Pete Wright:
Who’s doing that investigation, Dan?

Dan Ilnicky:
Yeah, so, the investigation really kind of starts, everyone that can be involved should be involved. If the employee, let’s say they weren’t even hurt, but they were involved in an incident that occurred, they should be involved with that, supervisors, managers, production managers, HR people, anyone that you can get into that process. I look at this as the more people that can see it and hear it and understand it when something isn’t happening correctly, you have now more people that can identify that, so get as many people involved in that process, get first shift, second shift, third shift, because maybe things look different or happen differently on different shifts.
Look at different workstations. Is everybody doing it the same way, or why is that one over there doing it a little differently? Let’s pay attention to that, figure things out. That two steps, we’re doing that, formal, upfront, “Hey, we’re going to look at this and make sure that it’s as safe as possible, and then if something does happen along the way, then we’re doing our incident investigation following that.”

Pete Wright:
It does remind me to just throw out the benefit and the critical importance of doing due diligence on those job descriptions, too, the implicit versus explicit job description. There should be no implicit duties that are hidden in that job description if you’re doing something that is in any way related to something where incidents could happen.
Lori, you were going to say something?

Lori Bourgoin:
In terms of the incident investigation, I think you both make a really good point. What I have realized in the many investigations that I’ve done is to make sure that you include witnesses to any incident that happens, an incident or a near miss, and get their statements of what they saw.
Also, any camera video that was in that vicinity, make sure you secure that so you can see exactly what happened in that situation. Take photos of the area at the very moment that you find this injury or this accident did happen. Take photos of the area because you never know where this case is going to go. Also, think about, “Did this area have any past injuries? Are there trends in this area? Is there proper lighting?” so there’s a lot that you can do in terms of investigations.
The other thing is is think about drug testing. Do you have a drug testing policy or drug-alcohol testing? Do you have post-accident drug-alcohol testing or near-miss testing and making sure supervisors and employees are aware of it and follow through on any of that testing. If you think to yourself, “No, we don’t have that,” maybe that’s one thing you take out of this podcast is maybe we’re going to bring some drug testing in in the event there is an unfortunate injury or incident that happens.

Pete Wright:
I think that’s a fascinating process sort of the end of the approach. I wonder if we could take a step backward to the beginning of the workers’ comp process because one of the things we teased at the very beginning was how important it is for HR professionals to understand the process from soup to nuts, A to Z. Can we walk through a sample injury or a sample case? Can you walk us through what are the common injuries HR pros should look out for and what are the conditions in which they should move forward through workers’ comp or move forward through bandaid and a pat on the back?

Dan Ilnicky:
Yeah. I think it would be easiest for us to have a general conversation about an incident occurring, right? Let’s not specify the nature of it because we can go down that rabbit hole and get into the weeds with that. The reality is is that an incident occurs. Let’s just say that, right? That individual, is it a first-aid-only type of a case, to your point, put the bandaid on, go through and do your incident investigation, but they remain at work? That’s a very cut-and-dry type of an incident.
Now, the workers’ comp cases will start to come into play when that person seeks medical attention outside of the facility and then may possibly have some lost wages. In Massachusetts, there’s a period of time that somebody has become injured and is out of work. There’s a period of time that will lapse before workers’ comp will truly kick in and, in Massachusetts, that’s five days. After that five days, workers’ comp really gets involved.
Now, with me saying that, that’s referring to a payment type process for what’s happening. Every incident should be reported. I encourage the near misses, so not just medical or lost time. Report every incident to your carrier. It’s not going to hurt you if it’s just a non-dollar-valued type of a claim and we’re just saying, “Hey, this happened. We want you to know of it.” We encourage that because things can happen a couple of weeks later. Someone gets an infection, and the first thing we do, “Well, how come we didn’t hear about this before?” Well, if we know about it, we can say, “Okay, we knew of the incident. It appears to be legitimate. Let’s make sure that they get the medical care and the attention that they need,” so, as the person goes and stays within a certain short period of time, maybe we anticipate that they’re going to be back to work in a relatively quick period.
That’s handled one way, but now, when we start going into a longer period of time, a person has doctor visits, ongoing medical attention, now they’ve got the lost wages. That’s what we refer to as a lost-time case, and that becomes more complicated and usually longer in duration. They all should be handled initially really the same way, and that’s to report it, make sure that the person has the medical attention and then start that partnership. Start that communication with the workers’ comp carrier. Keep the employee engaged. Everything that we talked about earlier, all that really starts to come into play at that point.

Pete Wright:
What is the relationship between workers’ comp and mental health conditions, trauma, those sorts of things?

Dan Ilnicky:
There’s a lot of legislative regulatory conditions. I know, in Connecticut, we just heard that, let’s say somebody experiences a traumatic event. Well, in Connecticut, in the past, it had just been first responders and coverage for first responders for that, but the legislation has passed where now it’s anybody. If you witness a traumatic event and you’re having some difficulty in dealing with that, we as a carrier are involved with how do we make sure that that person gets taken care of as well, not just the injured person or the person who unfortunately maybe have been deceased? There is some legislative action in each state. I know a lot of times we’re just focusing on Massachusetts, but there may be other people outside of Massachusetts listening to this podcast. Be aware of what your state allows for that type of a situation.

Pete Wright:
Sure. Check your local jurisdiction. Lori, you’ve handled a lot of these cases. Do you ever run into any that includes some of these sorts of complexities?

Lori Bourgoin:
Yes, unfortunately. I worked for a retail organization, and there have been robberies and such that have caused mental health, and they truly are an injury just like any other and should be treated in the same way. Working with your workers’ comp carrier is essential to really care and make way of finding a way to get that person back to work, which has always seemed, in my experience, to be the best for that person, whether it be in one location or another, to help them through any of the trauma that they are dealing with.

Pete Wright:
It’s refreshing to hear you both reflect on it this way knowing there’s still road ahead, but that the relationship between the worker and the employer going through the workers’ comp process, it’s a whole body experience, right? The whole employee is valued. Those of us who’ve been around long enough have seen, even the lowercase T, trauma cases, “Just put that away. You’re fine. Get back at the desk,” and it’s nice to hear some turn on that.

Dan Ilnicky:
As I look at it, one of the perceptions I guess I’ll call it is the injured workers, employers, workers’ comp carrier that it’s an adversarial situation, and it doesn’t need to be.

Pete Wright:
That’s certainly a stereotype. I think that is a stereotype, Dan. Yeah.

Dan Ilnicky:
Absolutely, it is, Pete, and we need to break that down because the goal really is to make that injured worker whole again. Sometimes, that injured worker, as they’re dealing with everything, yep, they’ll turn on the TV or they’ll get word of representation, attorneys, all like that, they’re out there. I’m not trying to downplay that part, but the reality is that, if they keep an open mind, the employer, the workers’ comp carrier, they really are trying to look out for that injured worker and trying to get them whole again. That’s the goal in the process.
I’m going to stay away from all the other stereotypes that are out there because we could really get way into the weeds on that, but the reality is that, if the process is set up and it’s, I’m going to use the word, transparent, “This is how it happens. This is what we do if something occurs,” the more transparency, the more knowledge about that, the better that system’s actually going to work for everybody. That’s really the goal.

Pete Wright:
I like hearing you say that. I think it’s actually a perfect way to get toward wrapping up our conversation today, and that is operating proactively with the presumption of goodwill on all parties. Everyone is trying to do the best to, as you say, make the employee whole again, promise of goodwill. Any place you want to share that people should go learn more about the good work that you both are doing with AIM and A.I.M. Mutual?

Dan Ilnicky:
Go talk with your workers’ comp carrier. I know, at A.I.M. Mutual, we’ve got a website. We have contact people. Just reach out. That’s the first place. That’s the best thing to do. If you’re not comfortable, if you’re not familiar with who your carrier is, make it that way. Make yourself comfortable and familiar with them because you don’t want to be looking for it, “So where’s that number? When something happens, who do I call? Where do I go?” Just be prepared because that again helps streamline that communication. That partnership right at the very beginning is really what’s critical whether it’s with A.I.M. Mutual or another carrier.

Pete Wright:
We learned it from Scouts. We learned it here again today. Be prepared. Lori, HR pros, last word?

Lori Bourgoin:
Well, those that are members of AIM can, of course, call the AIM helpline, but there are a laundry list of resources available through many governmental agencies. I will provide the link in the meeting notes so that those who are listening can provide certain… There’s workplace violence training that is available. There is safety training. There are a ton of resources on the FMLA, the ADA and policies to make sure employees are aware of everything that you do to help putting together a drug and alcohol-drug testing program. There are a ton of resources out there. Again, we are here to help our employees get back to work from an HR capacity, and companies want to do the same.

Dan Ilnicky:
At any point, reach out to aimmmutual.com for the website, or you’ve got aimnet.org. Both of those locations as represented here today will have a wealth of information available, and that information is free.

Pete Wright:
Meet your rep. Find the links. Swipe up in your show notes. You’ll find all the links that we’ve talked about in this show. We sure appreciate you sitting down and educating us, educating me, Lori, Dan. Thank you so much for your time today.

Lori Bourgoin:
Thank you, Pete.

Dan Ilnicky:
Thank you, Pete.

Lori Bourgoin:
Thanks, Dan.

Dan Ilnicky:
Thanks, Lori.

Pete Wright:
Thank you all for downloading and listening to this show. We certainly appreciate your time and attention. Again, swipe up for those show notes and listen to the show right there on the website at aimhrsolutions.com. You can find us anywhere great podcasts are served, Apple Podcasts, Spotify. Wherever you listen to your podcasts, we’re there. On behalf of Dan and Lori, I’m Pete Wright, and we’ll see you next week right here on Human Solutions, simplifying HR for people who love HR.

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