We had just finished the national bloggers’ panel at the National Workers’ Compensation Conference, where one of the things we had discussed was how employers can improve outcomes by being more engaged, concerned and communicative with their injured workers, especially early in the claim cycle. I was approached by an attendee who happens to be one of our customers, managing about 150 accounts in our WorkCompResearch Compliance system for his company, a well known national carrier. He asked a simple, yet critical question.

He said (I am paraphrasing, as I was not taking notes), “All of the people here are big employers, carriers or TPA’s. Most of our customers are small employers. How do we reach them with information like this?”

It was an excellent question, and one that I have posed to a conference group before. Last July, in a similar bloggers panel at CCWC, an employers association conference, I put that very question to the panel and the audience. As we talked about improving employer processes for better overall outcomes, it dawned on me that we were speaking to a very small segment of the overall market, and that most employers simply do not have access to the type of information we were discussing.

It is a big concern. According to U.S. Census Bureau data, businesses with fewer than 500 workers accounted for 48.5 percent of private sector payrolls in 2011, and those with fewer than 100 workers employed 34.5 percent. Businesses with less than 20 workers employed 17.9 percent. I would suggest that not a single one of the “fewer than 100” employers attends any workers’ compensation conference. Ever.

And as difficult as it is to fathom, they probably do not read my blog, either.

While I do not have immediate access to supporting statistics, I would lay a weeks wages that these employers have a reduced focus on safety, prevention, and training, as well as a disproportionate number of workers’ compensation claims activity for the nation. And “Return to Work” with accommodations is likely nowhere near their radar screens.

Small employers are generally oblivious when it comes to workers’ compensation, with the subject merely being a required expense line on their operating statement. They are, instead, largely reactive to issues related to the topic. My brother in law, a VP of Operations for a small medical equipment startup in Silicon Valley, called me one day a couple years back. The exasperation in his voice was palpable, as he asked me, “What the hell is an experience mod, and how is it calculated?” I told him if he had to ask, it was probably too late; at least for the foreseeable future, anyway. So reaching these people with culture changing advice and training is difficult, if not damn near impossible.

Who in our system could do this? Insurance agents? Doubtful. There is simply not enough incentive currently in the equation for that type of support to occur from that sector. I have an agent friend that told me once he won't even sell comp to any company with less than 4 or 5 employees, since there is little money in it and they are “a pain in the ass”; mostly because they have no internal support structures and lean heavily on the agent for HR style support and information.  Brokers? Maybe. These folks deal with the larger side of small and medium level employers, and have a bit more skin in the game. Still, driving useful and method altering information through that channel will often require a true paradigm shift for those in that industry segment.

Of course, that is actually the key. A paradigm shift is needed not just for brokers and agents, but for the industry in its entirety.  And like it or not, it probably should start with state regulators, followed closely by the carriers of this country.

Regulators are the key to driving process and affecting culture, but efforts such as this can start without their immediate intervention. Carriers, such as the one who employs the gentleman I referenced earlier, probably have the best reach and ability to affect and influence small employers across the country. They can do it through dedicated training and education materials, as well as establishing a culture of communication through their specific supply chains. They can do it by reinforcing positive methods and procedures for safety, and most importantly, they can affect the process when a newly injured worker enters the system.

I've written extensively about what I believe needs to occur within the claims handling process to improve outcomes for these employers and their injured workers. My ideal culture change involves streamlining processes, empowering claims professionals and improving medical care by rewarding performance – but mostly relies on vastly improved lines of communications between employers, employees and the professionals that are serving them. Communication that creates a “picture of success” (Thank you Bonnie St. John) for recovering workers. Much of what I would envision cannot occur without regulatory changes, but the idea; the culture of recovery can start with those of us within the industry today.

Comprehensive culture change will not be an easy task, especially since those damn small employers don't read my blog, however, it can trickle through the system if the right people and organizations pick up the torch and run with it. Truth be told, via all the blogs and conferences across the country, we are really only reaching a small percentage of large employers, let alone small. Improved process and communication can drive change from the top down, and ultimately reach employers, large and small, that unfortunately feed our system all too well. It won't be easy. Until employers recognize the critical nature of the topic they will continue to ignore it. It is up to us to start that change.

I'll be damned. It turns out we are the people we've been waiting for after all.

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