Make Sure Your Carrier Does Not Use Trapdoor Communications

Communication (a sharing of information) is essential to proper handling of workers comp claims. Workers comp has a complicated communication network which, moreover, operates with numerous time deadlines. Regulars in the field, especially attorneys and doctors, quickly learn to spot the pitfalls and work through, under, over and around them.

But what about your employees? Chances are, they trust and hope much, and imagine that the vast communication network on claims is forwarding the proper information to the right people. Perhaps the employer thinks the same. [WCx]

It might come as a shock to learn that some communication is far from being an effective exchange. It is, in fact, a one-way flow to the detriment of the unwary. This form of communication, which takes information from the worker, gives nothing back, and only stores what is detrimental to the claim, discarding nearly everything else, appeared about ten years ago.

A call is made to a carrier. When the caller is identified as a person with an interest in a claim the call is transferred to a person vaguely identified as a “claim resolution officer” or, perhaps, not identified at all. The caller is asked some of the usual questions but then is asked if there are any problems. If the caller asks any questions, they will go unanswered, with a variety of reasons given. In the end, the caller is referred to a different number, or told to write.

What has occurred is that the caller, without realizing it, has been involved in a recorded call, after which the call may, or may not be saved. A warning is given that the message may be recorded “to ensure proper handling”.

In fact, the person on the other end may have a law degree, but is not admitted yet as a lawyer. Normally, a lawyer who is admitted is required to advise callers that they are speaking to a lawyer. But a person not admitted does not have to mention that they have a law degree. The person taking the call has, in fact, received training in asking the proper questions, but providing no answers. Calls which are useful for the carrier are saved. Others are dropped.

If this sounds a bit over the top, it is. Fortunately, it appears to be rare.

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How can we be sure that this was, or is, going on? When lawyers began having such strange conversations with claims units, the professional tendency toward paranoia got the better of them and searches on the Internet were conducted. Several years ago, an on-line ad for new law grads “not yet admitted” to work as “claim resolution specialists” appeared, posted by a major company.

And any trial lawyer knows in a nano-second when they are speaking to a law grad.

The practice seems to have shrunk since then. Workers, as any lawyer can tell you, have rather acute senses when it comes to strangers asking even stranger questions. But the biggest brakes seem to have been the law grads themselves. Recent law grads have the zeal and optimism of newly ordained missionaries and do not adjust well to a job better suited to the most cynical private investigators. In addition, the grads were themselves not told precisely what would be involved. When the truth appeared, the job was seen to be a resume killer. [WCx]

Hopefully, the practice has ceased. But employers should take the trouble to ask the employees what sort of treatment they are getting from the carrier.

Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. [email protected]

WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

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