ADJUSTED
ADJUSTED
Claims Investigations with Karyl Bierwagen
In this rebroadcast episode, ADJUSTED welcomes Karyl Bierwagen, Senior Catastrophic Resolution Specialist with Berkley Industrial Comp. In this episode, Karyl delves into the art of conducting a successful investigation of a workers' comp claim. She highlights the importance of balancing technical knowledge with empathy to navigate the complexities of claims investigations effectively.
Join us as we explore:
- Understanding Compensability: Grasp the essentials of what makes a claim compensable.
- Empathy in Investigations: Learn why empathy is crucial in the investigation process.
- Thorough Evidence Gathering: Discover the importance of collecting comprehensive evidence, including witness accounts.
- Technology's Role: See how technology can enhance investigative efforts.
- Tips for New Adjusters: Get valuable advice on effective questioning and listening skills.
- Building Relationships: Gain insights on fostering relationships through shared experiences.
Tune in to gain practical tips and insights that can help shape a positive and effective claims process!
Season 9 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Matt Yehling, Directory of Claims at Midwest Employers Casualty.
Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkindcomp.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com
Hello everybody and welcome to Adjusted.
Speaker 1:I'm your host, greg Hamblin, coming at you from beautiful Birmingham, alabama, and I'm excited to share with you this rebroadcast. This one is actually particularly important to me. I've had the opportunity to work with Carol Beerwagon for almost two decades. I think I started one year before her and we were on the same team, so our careers have sort of followed each other along, taking different paths, but she's truly an expert in her field and in this episode we had the opportunity to dive deep on the investigation side and really talk about how do we investigate a claim so that we can get the best outcome and we have all the information to make the right decision. So I hope you enjoy this one as much as I did and just want to remind everybody to like, follow and share the podcast. Certainly, if you have time, we would love it if you leave us a five-star and leave a review so that others can find their way here and with that I'll remind folks to do right, think differently and don't forget to care and enjoy.
Speaker 1:Hello everybody and welcome to Adjusted. I'm your host, greg Hamlin, coming at you from beautiful Birmingham, alabama, where the weather is wonderful in December. We are in the 70s, 60s and 70s, so I'm not complaining about that. Having grown up in the Midwest, I was up there for the holidays and it was negative 30 with windchill, so I'm glad to be back in the South where it's warm. With me is my co-host today, matt Yaling. Matt, I'll go ahead and let you introduce yourself.
Speaker 2:Hello, this is Matt Yaling, and I'm joining you from St Louis, missouri, along the banks of the mighty Mississippi, and we're having some pretty good weather up here too today. So happy new year, everyone, and looking forward to 2023.
Speaker 1:Absolutely Happy new year. We have a special guest with us today, carol Beerwagon. She is a Senior Catastrophic Resolution Specialist for Berkeley Industrial Comp, so I have the pleasure of working with her regularly, so wanted to go ahead and let her say hello to everybody.
Speaker 3:Hi everybody, Thanks for having me on. I'm excited to be here.
Speaker 1:Yeah, Carol and I actually started within maybe a year or two of each other and we're trained by the same person. So if she's listening, I will say a shout out to Andrea Stott. She did a good job with both of us. So we're still here all these years later. So that's kind of how our paths crossed years ago. But maybe just to give us a little bit more of your background, Carol, I'm sure that you always knew you were going to be in workers' compensation, right?
Speaker 3:Not exactly something you dream of from kindergarten, but it worked out. No, I started at Indiana University for college and thought I wanted to be a fashion buyer and live in New York City. Changed my mind, decided I wanted to stay a fashion buyer and live in New York City. Changed my mind, decided I wanted to stay here in the Midwest and there's not a lot of fashion buying opportunities here. So I thought I would go into retail management, did an internship and realized that was not for me. So I went to a job fair just trying to find something that would pay me and that was close to home towards the end of my senior year and just kind of fell into my prior employer and at that point in time I didn't know what workers' comp insurance was, and so they really trained me from the ground up. So I worked there for about 16 years before coming here to Berkeley in September of 21.
Speaker 1:That's awesome. Well, I know the world will be shocked that Indianapolis is not the new Paris, but you never know. Right Things could change. But I remember when you started I was like apparel merchandising degree. That's interesting. I haven't seen that go into claims.
Speaker 3:It was a good business background and some marketing in there too, so it was a good general business degree, but definitely not where I saw myself when I started school.
Speaker 2:That's awesome. So how do we segue into? What types of claims do you work with in the workers' comp industry from the apparel merchandising background?
Speaker 3:Not too many fashion claims unfortunately Falling off the runway and that kind of thing, yeah but the claims I'm handling now are mostly serious loss and catastrophic claims and I really enjoy that type of work. I kind of eased into it just learning to handle some of the more complicated injuries and more complicated legal claims and really enjoyed those. Those were my favorite to work on. So I've been learning a lot. There's never a dull day.
Speaker 2:So when you say serious loss and catastrophic claims, maybe break that down a little further. What's that entail? What kind of claims are you seeing? Are these auto accidents or slip and falls, or a little bit of both? Or what's the general day-to-day breakdown of those look like for you?
Speaker 3:Yeah, it's a little bit of everything. So we do have some mining claims that we see some serious injuries with A lot of tools, the industrial tools that they're using. Sometimes they're tools that have malfunctioned, but more often than not it's tools being used in a way they shouldn't be used or safety mechanisms being disabled and injuring folks saws, falls from great heights, motor vehicle accidents, chemical inhalation, those kinds of things.
Speaker 1:Yeah, there are definitely no dull days on our CAT team and for those who don't know, Berkeley Industrial Comp, we specialize in high hazard workers' compensation insurance, so we don't have a whole lot of frequency. We don't see a whole lot of small little claims, but when we do see injuries they're pretty challenging because of the types of businesses that we insure. So great questions. Matt, I'm glad that you asked that.
Speaker 1:Our topic for today is claims investigation. So I wanted to bring Carol on to talk about this because she's been doing this for a while and it's a big part of claims is making sure we understand exactly what happened, how it happened, to who it happened and making sure we know what we're covering. And so I wanted to maybe start before we get too deep into claims investigation. And just I'm going to throw a word out there that may not be familiar to everybody who's not in the workers' compensation space, but would be for maybe an adjuster, and that's the word compensability. So obviously a lot starts at coverage and compensability, which are the beginnings of any claims investigation. Carol, do you want to talk a little bit about compensability?
Speaker 3:Yeah, so the high level definition of it is if a injured worker is in the course and scope of their employment at the time of the injury, and so what that means in English is were they at work and working when the injury occurred, and was the injury work related? And so, in order to determine those things, you have a lot of questions to ask, and that's why we need to investigate the claim.
Speaker 2:Yeah, so you mentioned this earlier about the types of accidents you're seeing. Sometimes there's machinery or equipment or they're working from heights and other things. So maybe a leading question here. But why is that investigation so important to you know, to confirm compensability and to kind of outline the claim?
Speaker 3:Well, like all of our lives, they're complicated, and so just because somebody falls at work, just a fall in and of itself, that's not enough information. Where were they when they fell? What were they doing? Were they working at the time? Were there drugs or alcohol involved? How high up were they? Did they have safety gear on? Did the safety gear malfunction? All of those answers can really play into whether or not a claim is compensable and beyond compensability. It also helps us understand how the injury occurred, which is important to understand the injuries themselves, and then it also helps us to identify potential safety issues with that insured. Maybe it's a fluke or maybe it's something that needs to be addressed so that future serious injuries don't occur.
Speaker 1:And that's an excellent point. One that sometimes we forget about is just how important it is to make sure that we're looking at this through the lens of the future too, because the next injury we could avoid from learning from how this happened especially with our insurance that are doing some pretty difficult tasks. You know, something as simple as making sure people have the right safety equipment at the right time and the right training could avoid something that could happen in the future. So I think those are really good points. One of the things that happens in the industry is we take statements of our injury workers, hopefully towards the beginning of the claim, when all the information is fresh. But, Carol, can you talk a little bit about the importance of statements and what's important when a adjuster's taking a statement?
Speaker 3:Yeah, so I think a recorded statement's important because it memorializes the conversation. That way the adjuster can refer back to it later if their notes don't reflect something specific that was discussed. Or it may be that that statement is needed down the road in litigation if the injured worker makes statements contradictory to what was said during the recording. So it's important that we have that conversation memorialized.
Speaker 1:So, in that, as you think about a statement, taking a recorded statement, what are some of the important things to cover? What are some of the things that you want to cover when you take a statement?
Speaker 3:happened? What specific body parts are involved? If somebody hurts their back, that can go up the back into the shoulders and the neck, it can go down into the hips and the legs and we can view that sometimes as what we call body creep, where these injuries keep moving. But sometimes it's also that, hey, when I fell and hurt my back, I also hurt my knee, but I didn't really tell you about my knee at the beginning because my back hurt worse. So it's really important that we ask specific questions to understand the full extent of their injuries and then again understanding the circumstances around the injury. So sometimes we can identify specific defenses or issues with compensability during the statement. For example, if someone might have been on medication that they shouldn't have been working on, that can be a potential drug violation. You know, that might be something we need to look into a little bit further.
Speaker 2:So I mean, when we talk about investigation we've been talking a lot about, you know, the injured employee, but the investigation is not just, you know, that single person right, sometimes there's witnesses, and so you know what other levels of investigation and who else are you talking to during your investigation period.
Speaker 3:Yeah, so there's lots of other folks that we need to talk to outside of the injured worker.
Speaker 3:I would say our ramp team is really important when investigating because I don't always understand the job industry that this person is working in or understand the names of the tools or the terms that are used.
Speaker 3:I can Google it but that doesn't always answer my question and our ramp risk management team is really great at being able to explain that further and explain if a injured worker statement or a mechanism of injury makes sense or if there's more questions that need to be asked that I would not otherwise know about.
Speaker 3:And then I think also defense counsel has been a really great resource for me as well. Even before I think also defense counsel has been a really great resource for me as well. Even before I make any investigative phone calls to understand the jurisdiction, you can read an accident summary and some basic information off of a first report of injury and already develop some questions and wonder well, is this compensable in this state? What are the specific rules around that type of injury or circumstance in this jurisdiction? And so sometimes I pick up the phone and call defense counsel and ask those questions before I even contact the employer or the injured worker. That way I can develop a list of my own questions to ask when I'm having those conversations with the employer or injured worker.
Speaker 2:Sometimes my kids read Amelia Bedelia and sometimes we take things so literally and it's like you talked about bringing in the ramp team and not understanding the industry and not being a specialist and everything. It's like sometimes it's good to know somebody that's involved in trucking. So you're talking about, you know, a reefer truck and you're like what the heck is a reefer truck? And it's like, oh, it's a refrigerated truck. So, like you know, when we're seeing these first reports of injury, it's, you know, somebody was climbing on top of the reefer truck and I'm thinking Cheech and Chong driving down the highway and I'm like what the hell does that mean and then like no, that's a refrigerated truck.
Speaker 2:I was like, oh okay, well, why didn't you just say that? Like well, we refer to these things differently so we all have our own kind of terminology and stuff. So when those injury reports come in, you know you start to my head jumps to like probably the worst possible thing and sometimes it's, you know, easily explainable. And yeah, that Amelia Bedelia mentality of thinking of things very literally. Sometimes you need the clarification.
Speaker 3:Absolutely, and I think witnesses are a big part of that investigation as well, because they offer another perspective of the injury, and when I say perspective, I mean that in several ways, both visually, because they saw the accident occur from another angle. They might've seen the surroundings of the injured worker that the injured worker themselves did not see. But they can also help, corroborate or impeach the injured worker or other witnesses. In fact, I had a claim recently where one witness supported what the injured worker said and then two others completely contradicted those stories. So it's really important to speak not only to a witness but to all of the witnesses.
Speaker 1:And that's an excellent point. Sometimes when we get in the check the box mentality, where we talk to the injured worker we say okay, there's a witness, and we talk to the witness and we move on without really thinking about the whole picture, we can get ourselves in a little bit of trouble and miss out on all the information of what exactly happened. So I'm glad that you pointed that out. One of the other things that you talked about there that I thought was interesting you talked a little bit about first reports of injury and I think both Matt and you hit on something that sometimes what's on there either we don't understand it or it might not always be accurate.
Speaker 1:I know we've seen times where we've had a claim reported as a medical only claim, only to find out that it's much more severe. I can think of one that we had, that said, a head laceration, and we found out later that he had had a grinder go through his forehead, which is a lot different than a head laceration, obviously. So we're talking about a very serious traumatic brain injury. Luckily the injured worker did recover from that, but we didn't know about it initially because it had been classified wrong. Carol, can you talk a little bit about first reports of injury and the importance of kind of confirming with the employer what actually happened.
Speaker 3:Yeah, I think a first report of injury is sort of my first line of investigation. So as soon as I get a new claim coming in whether it's new or even if it's a few weeks or months old I always start with the first report of injury. Not only does it give you a summary of what happened, but it also says who reported the claim and it gives you an idea of where the employer is located, where the accident occurred and where the injured worker lives. That's important because sometimes those aren't always in the same city or even state. So if you've got an injured worker who's seriously injured in Ohio but they live in Texas, you've got some work ahead of you to try and get them home for recovery where they have familial support and where they can be with their belongings and have to move doctors from where their original injury was to their home state. So those are all important things to know.
Speaker 3:Going into a claim. It's also helpful to confirm that you're in the right jurisdiction to be sure that the claim was reported correctly, and that's certainly important because every state has different laws. You want to be sure you're handling the claim in the correct jurisdiction and following the correct laws. And sometimes those first reports of injury also identify the people you need to talk to, obviously not only the injured worker, but the person who reported the claim. You certainly want to speak to them, and sometimes they also list the witnesses and the initial medical provider. So that's all really important information and kind of your first step on the investigation journey.
Speaker 2:So where does empathy fit into the claims investigation versus a just-the-facts-ma'am approach to investigation?
Speaker 3:I think the point of the investigation is certainly not to drill the injured worker. So sometimes we can get into the habit of going through just the questions that we've developed or perhaps that are even on a recorded statement. Instead of just going through basic questions, we want to listen to the individual. There's multiple reasons for that One. They're a human being and they deserve to be listened to, and that is a way of showing empathy not just waiting for them to be done talking and moving on to the next question, but genuinely listening and hearing what they have to say, hearing what their concerns are.
Speaker 3:Sometimes there's follow-up questions that need to be asked, and so that's important as well. But again, the point of an investigation is not to drill someone. We're meeting these people at some of the lowest points in their lives. They're hurt, they're scared, they don't know how they're going to provide for their family, and it's our first chance to not only investigate the claim but to explain the workers' comp process and build a relationship and a rapport with them and tell them what we're going to do to try and help them get better and provide for their family in this scary time.
Speaker 1:I think you really hit on some really important concepts there, and I think, unfortunately, there's a thought process that insurance companies are looking for ways to deny claims and ruin people's lives, and that's just, you know. Obviously, our goal is to do the right thing and we want to do the right thing for everybody involved, and it is a balancing act because we have a policy holder that's paying us a premium, we have an injured worker who's hurt. There's a lot that we're trying to do when we say do the right thing. And empathy, in my opinion, is where it starts.
Speaker 1:Obviously, you know, I think of our injured workers a lot, like I do my children. I know people say I have, you know, I talk a lot about how I have six kids, but you know, I trust my children to a point, because I remember I was a kid once too, and I was a pretty good kid, but my parents didn't know everything I did, you know. So we hope that our injured workers are always coming at this with the right attitude and the right thoughts. But you know, we do have to make sure that all the facts line up and that what we have is a compensable claim before we start paying for something that maybe isn't, and we've seen some examples of that. Unfortunately, they're the minority, but they do exist. So, when you are taking a statement, why is it important on our end to keep our own judgments and assumptions in check? Because obviously we all have our own biases.
Speaker 3:Wow. Well, I think, first of all, it's just a good life skill to develop. We want to treat everybody as we want to be treated and not be judged or have assumptions made about us. But I think specific to investigating a claim if we assume, we're usually going to be wrong and if we don't ask, we don't know.
Speaker 3:So in order to investigate thoroughly, we need to know what we don't know and then we can ask the questions.
Speaker 3:And again, so much of that starts with follow-up questions and listening to the injured worker, not just moving on to the next question.
Speaker 3:If we just hear the basic information that they're willing to share right off the bat and not dig in and ask further questions, there's going to be a lot of information later down the road that you realize you don't know and then it's harder to go back and ask that person details later. For lots of reasons, Memories fade, attorneys get involved, and if we can ask the question right at the beginning, then we have a very clear understanding of the facts. And that goes for investigating a claim with compensability, but also things like hey, what's your house like? Do you have a lot of stairs? Is your bedroom on the first floor? If someone's severely injured and they're going to end up going home after some time in rehab, we need to know what kind of modifications might be needed for their home or what sort of equipment they might need to serve them best while they're at home. And it's a lot easier if you know all that information up front than trying to chase somebody down to get that information later.
Speaker 2:Yeah, if there's family, friends who lives with them, all that good stuff that you're going to be asking. So, there's generally a lot going on during that initial few days of the investigation. What are some of the other documents that you like to obtain and review during your initial investigation of a claim?
Speaker 3:Yeah. So again, the first report of injury is where I start and then I usually go to an index report. So I'm looking to see if they have prior injuries that pertain to this claim. Are they litigious? Can I expect an attorney on this claim? And when I'm looking at prior injuries, I'm not just looking at oh, this is a shoulder claim. Have they had a shoulder injury before? We all know that body parts are connected, so a prior head injury or neck injury might be relevant to this shoulder claim, because we all know that a lot of neck pain can go into shoulder and vice versa.
Speaker 3:I'm also looking at the policy to confirm coverage. I'm looking at medical records to confirm that the mechanism of injury matches what I know to be true, what their medical history is and whether or not that might impact recovery and healing. Somebody who's a diabetic and a pack a day smoker and has a injury. That's not a good thing and I need to be aware that their healing is going to take a little bit longer. And then again I'm looking at witness statements that maybe have already been taken by the employer. Sometimes there's written statements from witnesses when insureds can provide their own investigative reports that they've done. That's super helpful.
Speaker 3:It's again another take on what happened to cause the injury. If there's photos, those are really helpful. Instead of imagining the scenario, I can physically see it videos of the injury or even just of the job that the person was doing. So, for example, I had a driller who had a drill come down a very large drill, mining drill come down on his foot. I didn't understand what he would have been doing at the time and how this injury occurred. The employer was able to send me kind of a series of photos explaining the job that he was doing and that way I was really able to piece together what happened to cause the injury. So those things are all really important to have.
Speaker 1:One of the things you were mentioning. You know getting videos or photos from the insured One of the things that's been more common that I've seen and I'm wondering if you've seen this as dash cams or surveillance video, like at a gas station or somewhere else. You know that that has, like you know, security video footage and police cams now are a new thing that we're starting to see more of. So have you seen any of those things play into your investigation?
Speaker 3:Yeah, I've had a couple instances where the insured's closed circuit TV system has really helped. It's shown the injury or has shown aftermath. I suppose you would say we can confirm timing, we can confirm who was there. Sometimes we can see the injury itself happen. If a third party is involved, we have evidence or proof of that. In terms of subrogation, that's been really helpful. The black boxes in vehicles most modern vehicles now have their own version of a black box, so that can be really helpful, especially with motor vehicle accidents, to determine how fast the vehicle was going when someone started braking, the timing of impact. Those sorts of things have been really helpful to have as well.
Speaker 2:Sharon, I think you hit on a word that I don't know if we've had this topic on subrogation and maybe we have, but that's a pretty big thing for an insurance company. Workers' comp is no fault. But if there's another party that you mentioned like flips from heights or falls, safety equipment where it's either you know it's failed or something else has failed, or a motor vehicle accident, all those kind of raise another level of investigation right around subrogation. And is there another party at fault? Is there another potential recovery available for both the injured employee and, you know, the insurance carrier potentially? So I mean, I think that's a big part of that in this investigative piece that you know we could probably spend a whole nother podcast just talking about subrogation in general. So you know.
Speaker 2:So there's lots of things you know, I know from being on the front lines and doing those investigations. You know there's you start opening up, you know, what could seem like a Pandora's box of investigation on some of these claims, the more complicated they are. So what's an important you know, and you mentioned mechanism of injury earlier too. So why is that important for you to use and what's you know, what's that going to help explain, you know, for you during the investigation of the claim.
Speaker 3:I think the mechanism of injury is important for several reasons. It's going to again help us determine that the injured worker was doing their job, was working at the time of the injury. It's going to help us identify future safety issues. You know, if the job that they're doing is unsafe and that's what caused the injury, then how can we make it safer in the future? That's something that our ramp team and our underwriting team both need to be aware of. If safety issues like that are identified, specifically ones that we've seen before over and over with the same insured, I think making sure that the mechanism of injury and the diagnosis itself makes sense is important. I have no medical background, no medical degrees, but just common sense comes into place or play Sometimes, you know being sure hey, if something fell and landed on my left foot, then why does my shoulder hurt? You know things like that.
Speaker 2:Yeah, I mean, I think there's a lot of truth to that. How do you improve something so that you know we can prevent this injury from occurring? How do we ensure that we're putting our injured employees in the best possible position to both be successful for whatever organization they're working for, and to return back home every night for their families? So I think that investigation is an important piece of how do we improve the process to avoid this ever happening again and ensure they're preparing for an appropriate loss.
Speaker 2:I know Greg has a final question for you too.
Speaker 1:Yeah, well, I actually just had a couple of thoughts I wanted to pick your brain on as we wrap things up, but one of them was so having done this, carol for coming up, I don't think you're getting close to 20 years now doing this. If you could go back and tell Carol in year one don't forget to do this part, because I've learned a lot in that time what would be the thing that you would say, hey, you know. Going back and telling you 20 years ago, what would you tell yourself, don't you know? This is the part you need to not forget about it. On a claims investigation.
Speaker 3:I think there would be two main things I would tell myself. The first would be, again, not to stick to that recorded interview script. I think initially, when workers' comp adjusters are new at investigating, we can get nervous and hyped up about wanting to develop a rapport with someone. But also be sure we thoroughly investigate and we get overwhelmed easily on the phone, especially if a conversation goes in a direction that maybe we didn't expect it to go.
Speaker 3:So, really having sort of a list of questions typed up or written out on a note that I want to be sure and ask it's not necessarily what's on a recorded statement script, like I need your address and date of birth and those sorts of things those become common sense to ask or to verify.
Speaker 3:But to really get to the heart of that specific person's injury and not use generic questions and listening to their answers and asking follow-up questions. That would be the first, and the second I think it ties in with it is to be empathetic because again, as a new adjuster, you're so concerned about being sure that you get all the questions answered that you can get into this robotic like tone almost, and you forget that these, this person, has a life when they hang up the phone with you and they have questions and they're scared, and so if you can make them feel better by providing answers to their questions and giving your contact information really basic stuff that seems like common sense, but sometimes us new adjusters are so busy that we just got to get our questions answered and get off the phone so we can move on, and that's really harmful to both parties when we do that.
Speaker 1:I'll tell you what, carol. I'm so glad that I had you on this episode, because the things you highlighted, I just think are missing in a lot of people in this industry, so I'm glad that you pointed that out the curiosity, asking questions, good questions and really trying to understand. And then, I think, the other piece of being sure that we show empathy and that we don't forget that they're going through something difficult, regardless of what our job is, to make sure that we do those things is something that the whole industry could learn a little bit from you on. So thank you for highlighting that. You know, one of the things I wanted to highlight this year, as we move into 2023, is I wanted to ask each of our guests something that they're grateful for. I feel like we live in a world where there is very me-centered culture, and so I'm going to try to, this season, put some, again, good vibes out in the universe, and my thought is just to ask people what are you grateful for?
Speaker 3:I'm grateful for my family. I have a fantastic husband and two really great daughters, 10 and 13. And then I have extended family close by that we have great relationships with and that are able to help when we need it. And I'm grateful for my job as corny as that sounds, I work to live, not live to work. And my job allows me to keep my mind busy and be intrigued and to learn, but most importantly, it helps me to continue doing what I love doing, which is being with my family and enjoying my time and providing for them.
Speaker 1:Well, I absolutely love that, Carol. I think that's obviously a lot of the reasons why we do what we do and really appreciate having you as a guest today. And we'll just remind folks our theme to do right, think differently and don't forget to care. And with that we will wrap up this episode and hope you'll follow us in future episodes releasing every two weeks on Monday. You can also catch our blog on the off weeks that is written by our wonderful Natalie Dangles. So again, remind everybody to do right, think differently and don't forget to care. And that's it, guys. Thank you.