A personal touch for workers' compensation claims

Work accidents, like any injury, can be life-altering — both for the employee and his or her family. They can also be business-altering and have ripple effects for business owners.

Sandy Prior, a claims manager for Grinnell Mutual’s workers’ compensation product and registered nurse, knows this as well as anyone.

And, as a former nurse case manager (NCM), Prior knows having a face-to-face relationship when there is a workers’ compensation claim can make a world difference for the injured employee, the insured, and the carrier.

“I know the impact that nurse case managers can have on helping claims go so much more smoothly,” said Prior. “They have the deep medical knowledge that most claims adjusters don’t. And they go to appointments with the injured employee, so they’re there to help explain what’s going on and can ask the doctors questions and help assess the suggested treatments.”

Like other insurers, Grinnell Mutual usually contracts with NCMs. But Prior thought having one on staff could be more efficient and cost-effective. Most importantly, it would offer the best service to both the insured and the injured worker. That’s why she led the effort to create the position at Grinnell Mutual.

“Sandy has worked in different facets of the work comp insurance industry for a long time and she has a wealth of knowledge on the subject,” said Paul Boonstra, a director in the Claims division. “She was instrumental in leading the effort to budget for and hire a nurse case manager for our work comp business in the state of Iowa.”

Relationships at the center

Enter Jodi Suther, RN, BSN, who joined Grinnell Mutual in April 2019.

“My role is to help manage all the medical aspects of a workers’ compensation claim,” Suther said. “I go to doctors’ appointments with the employee and make arrangements for other treatments like physical therapy and in-home equipment.” Suther also helps with transportation needs and referrals to various social services if they’re needed and checks in on claimants throughout their time off work.

“As an advocate for the injured employee,” said Suther, “I want to make sure they understand the process, both medically and from an insurance standpoint.”

In one case where a mother of five was injured, Suther even arranged school pickup so the father could work. “They pretty much have 24/7 access to me,” said Suther.

“We cannot say enough good things about Jodi,” Boonstra said. “She has a huge heart and so much knowledge in the work comp arena. We have noticed huge improvements working with the injured employee as well as working with our insureds.”

Having Suther on staff, Prior said, makes things move not only more smoothly but faster.

“When someone is injured, especially in the case of a catastrophic injury resulting in hospitalization, Jodi can be there quickly,” she said. “The sooner we can make contact, the sooner they know that we’re there for them, and the sooner the claims process gets moving.”

Suther acts as a sort of medical translator, too, not only for the claimant, but for the insured and the adjuster, which helps nip miscommunications and misunderstandings in the bud.

All of this, Suther said, helps the injured workers, their employers, and Grinnell Mutual.

“Decreasing lost or modified work time helps insureds minimize the impact on their business and the potential for higher premiums,” said Suther. “And it helps injured workers get back to normal — even if it’s a new normal — as soon as possible.”

The human touch

There are a lot of business reasons why hiring Suther was a great move for Grinnell Mutual — and other reasons, too.

Having an advocate — a human face they can relate to and count on — makes injured employees more comfortable and less stressed, which in turn positively affects their healing time and their feelings about the experience, which in turn decreases litigiousness.

“Having a staff nurse case manager does save Grinnell Mutual money,” Prior said. “But that’s not why we value Jodi. She’s there, in person, for injured employees. One of the most important things we can do is let that person and their family know that ‘We got you. It’s going to be OK.’”

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