Employee Advocacy Approach to Workers’ Compensation


The workers’ compensation industry continues to shift to an employee advocacy-based model for claims, disability and nurse case management. That’s good news, as this model responds to the escalating challenges faced by injured workers, including treatment delays, limited access to care, economic uncertainty, the need for mental health resources, and limited social support structures.

"The goal is to remove uncertainty for injured workers from day one."

David Huth, Vice President of Managed Care, PMA Companies

To successfully implement an employee advocacy model to engage injured workers, increase employee satisfaction and optimize claim and financial outcomes, consider these four pillars:

  1. Communication. The goal is to remove uncertainty for injured workers from day one. Apply nurse injury triage to help address injured workers’ medical concerns immediately. Listen to their concerns and provide answers in easy-to-understand language. Be sure to avoid jargon, such as “indemnity payments” instead of “replacement wages.” Communicate with the tools your workers are most comfortable using. For older workers, that may be phone calls/emails, and for younger workers, consider texts and online chats.
  2. Empathy. Prioritize treating injured workers with respect and compassion. Recognize, acknowledge, and address areas of potential anxiety, including concerns around job security, medical treatment, and prescription medications. Leverage your insurer/TPA’s resources and tools to address the physical and psychosocial well-being of injured workers. Invest in building “soft skills” among your staff.
  3. Objectivity. Treat all injured workers equally throughout their recovery/return to work. Approach interactions with injured workers in a positive, supportive way and take the time to understand their individual situations and needs. Inquire as to your insurer/TPA’s use of evidence-based clinical guidelines in order to reduce variations in care among workers.
  4. Responsiveness. Set clear expectations for recovery and return to work. Follow up and deliver on these expectations. Work with your insurer/TPA to facilitate rapid access to appropriate care. Focus on a holistic view of the injured worker’s experience and improve convenience. Your insurer/TPA can be an excellent resource to proactively anticipate injured workers’ needs and solve problems. Addressing problems before they occur builds trust and engagement.

Implementing and optimizing an employee advocacy model can yield many positive benefits for your injured workers and your organization.

Originally published in Risk & Insurance magazine.

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David Huth, Vice President, Managed Care

David Huth is Vice President of Managed Care for PMA Companies. He leads the managed care strategy, staff, and operations for PMA’s nationwide insurance and TPA subsidiaries.