Longshore Insider
Longshore Insider
How is COVID-19 Impacting Longshore Claims Handling and Medical Treatment?
During the COVID-19 pandemic, many businesses in the maritime industry are considered essential. And as employees continue to work, claims will inevitably occur. This episode discusses how the pandemic is impacting longshore claims handling, how medical treatment is changing for injured workers, and the impact that fear has on the treatment process.
Featuring:
- Dave Widener, director of claims advisory services, The American Equity Underwriters
- Brian McElreath, partner, Lueder, Larkin & Hunter
Longshore Insider is a production of The American Equity Underwriters, Inc. Through webcasts, podcasts and blogs, we cover safety, claims, operations and more, all to help waterfront employers run and grow their business while controlling costs.
David Widener: So Brian, how you doing?
Brian McElreath: Great, Dave. Thanks for having me. Good to have some social interaction and to talk to somebody.
David Widener: Right. I know you're like me, and you're lacking in the adult social interaction right now, I believe.
Brian McElreath: Very much so. Lots of kid time and lots of inside time. Not a lot of adult social interaction. So, the good folks at AEU are always coming through for me. And I appreciate it.
David Widener: I'm glad to help. Well, we hope you can shed some insight on some of these interesting topics we have to talk about today. Currently, we're facing a pandemic and many cities and counties are having citizens self-quarantine. This obviously presents challenges to nearly every aspect of life, but fortunately in our industry, many employers can continue working as essential workers. So business goes on, I wouldn't say "as usual" with obviously new precautions, but business goes on. Claims are still happening. Employees are getting injured at work. And the claims we already have open are still moving along. So from a claim standpoint, how have you seen this current situation affect injured workers receiving medical treatment?
Brian McElreath: There has been an effect on medical treatment. So I'm in Charleston, South Carolina, and do a lot of stuff throughout the Southeast. And as you well know, a lot of medical providers placed a pause or a hold on non-essential treatment, even surgery. So if you need a knee surgery, you need your knee scoped or you need shoulder surgery, unless there's something that makes that urgent, that got put off and delayed for anywhere from a month to six weeks, to up to two months, in some locations, depending on how the locality was hit. And so, one of the initial challenging aspects was just making sure that care was continuous and moving forward. And so now, at least fortunately in the Southeast and the Gulf Coast, we seem to be lessening the restrictions and may be coming somewhat out of this back into a newer normal. And doctors are reopening to non-essential service.
So now we're able to get claimants back in for treatment. But now we're seeing another ramification of claimants being fearful of going to the doctor for treatment. That leads us to parse out -- is this a legitimate fear? A lot of us have fear and trepidation about many things. ("When can I go to a restaurant again? I can go now, but is it safe for me to go?") Rightfully so, claimants think the same thing about going to the doctor. But you have to figure out if that a rational fear or is this some sort of gamesmanship that's being played with the claim that is seeking to prolong the claim and maybe prolong benefits during a period of time of uncertainty. If you have a certain check coming in for weeks and you can maximize that by dragging out your medical treatment, does it create some perverse incentives to maybe not want to go to the doctor?
So you have to try to discern which claimant has a rightful fear. Are they in the age range that makes them more susceptible? Do they have comorbidities that maybe make them more susceptible? Or are they like you and I, and are relatively younger and healthy -- and as long as their doctors are taking the proper precautions, should be attending their appointments?That's been the most challenging thing right out of the gate with this, as far as medical treatment.
David Widener: I agree. That's certainly a challenging aspect of the whole situation. And I know with my Department of Labor background, lots of times when I'm asked, "How will DOL see this situations, especially with our claims here with ALMA?" Especially during the time of lockdown, if your county, or your city, or even your state was in lockdown and you weren't able to do the elective type surgeries -- I have a hard time seeing an ALJ not finding that refusal to go to the doctor unreasonable.
But, obviously as we get out of this now, just like you said, there's going to be more opportunities for people to leave the house and go to the doctor. Things are getting safer in that aspect. There certainly will be gamesmanship just like there is in every aspect of claims, especially as we move towards litigation and just trying to resolve just disputes with injured workers and their attorneys. Have you seen any innovative strategies that employers or carriers are using to continue the medical treatment and move claims?
Brian McElreath: Yeah. Not to stroke your ego, but as usual, AEU is kind of on the leading edge of these. There has been a rapid growth in the use of telemedicine just to keep continuity of care. Obviously, you can't perform a knee surgery over telemedicine, but if you have someone that is maybe post-knee surgery, or pre-knee surgery, or is treating conservatively, you can keep some continuity of care with telemedicine. There have been a lot of providers that were able to shift and pivot to that pretty quickly, both to provide the service to their clients, the claimants. I guess it also helps them because they're keeping the practice open and their families and their staff fed. So there's been that. There have also been carriers that have been willing to maybe authorize some treatment outside of the normal area.
If Charleston is on lockdown and you can't have someone seen in Charleston, but you have someone that needs some kind of treatment that they will provide in Myrtle Beach, 90 miles away, or Buford, 75 miles away, maybe you bite the bullet and pay for the transportation or the mileage. Or if the claimant wants to get that care, and you let them go to Myrtle Beach, you let them go to Columbia, you let them go to Buford or Savannah, because paying that $200 in mileage pales in comparison to an extra six weeks of TTD that you were paying, if they're just sitting at home, waiting on that appointment to be delayed for a month or six weeks.
So there have been some innovative strategies, and the AEUs of the world have certainly been on the forefront of pushing those strategies. But most claimants, to their credit, have been willing -- as we all know, most claimants aren't bad claimants. They want to go back to work. Most claimants have been willing to pivot as well. And if there's something that helps them get better and provide for their families quicker, most are willing to consider it.
David Widener: I know from a legal aspect, we've always shied away from the telemedicine-type visits and virtual clinics and stuff like that. Because when you're in court, when you're before an ALJ, they're going to give more weight to the doctor that's actually touched the patient and had a face-to-face conversation, rather than someone that's just seeing them and hearing complaints via Skype or online at some other aspect. But, do you see this type of medical treatment having legs and moving to where we're going to see it more in the future?
Brian McElreath: I think it certainly has its place kind of in the toolkit. I don't think it becomes the predominant treatment, but does it have a place in the future? Absolutely. And I think if there's been any kind of silver lining, just from the claim standpoint, it's forced everyone on all sides, judges, us on the defense side, claimants and plaintiffs on the other side of the ball, to consider maybe we can do some of the stuff that we've been hesitant to consider in the past. For whatever reason it may have been. And so I don't think it overtakes person-to-person care, because as you noted, there's nothing like sitting across from ... this is fun to talk to you right now and see you. But it's not like having a beer with you.
David Widener: Right.
Brian McElreath: I can't wait to give you a hug when we get finished and all of this is over. And so I think that's kind of how medicine is. Is it better than nothing? And does it have a place? Absolutely. Does it become the predominant treatment? I don't think so. But, are there areas where maybe it does? The DBA industry, maybe. If you're black lung, and you have people in outlying areas of West Virginia or Kentucky that have two hours to get to the doctor. What's the harm in mixing in some telemedicine every third appointment or something like that? I think that's maybe where it comes into play more so than you're going to get only telemedicine. Maybe every third appointment becomes telemedicine to ease the burden on both claimants and on providers.
David Widener: That makes a lot of sense. I know you mentioned DBA -- it's something we've seen in DBA for many years, especially with psych cases. There's just tremendous amount of PTSD claims in the DBA. And so, you do have a handful of experts around the country that it's very expensive to fly them all over the world. So you do have a lot of that telemedicine work in there. I think we've seen it with the traumatic injuries now and the orthopedic type injuries, it's nice to see. I agree with you. It's nice to have another tool in your toolbox.
And what I'm impressed with is, during this pandemic, Medicare's kind of embraced it. They changed some regulations to make that care more easily reimbursed under Medicare. And I think it's caused some doctors to move forward, and getting the better equipment, and more robust software and stuff like that, so that they can provide this type of service. Which was very handy at this point in time. Can you think of any other lessons learned through this just as far as medical treatment goes?
Brian McElreath: Well, I think the one thing, and this may be an unintended consequence, but I think a lesson kind of going back to the telemedicine is I think, as this becomes more ubiquitous throughout the medical community... I know my company, like most big companies, we shop our health insurance with rising rates every two or three years. And our new provider has a telemedicine app for your phone. And rather than being a stubborn man, like usual, and just trying to gut stuff out, now that I have that option, I'm going to get treatment for stuff that I would have just gutted out and been miserable for a week or 10 days before. Because I can just go on the app, text the doctor, the doctor calls me and says, "Hey, what's going on?" And I tell the doctor, he or she, what's going on, and they call me in a prescription. I feel better in two days or three days, rather than gutting it out for a week.
So I think there could be a lot of benefits kind of on the front-end, preventative health, which hopefully helps mitigate the injuries that you and I see on the back end. I think that's the one thing. I also think, personally, a lot of people during this time have been forced to slow down. A lot of people have started taking their health more seriously and going on walks. I think that's the kind of preventative care on the front-end that may ideally help us on the back end. Even if you don't see a drastic decrease in injuries, less comorbidities hopefully leads to lesser treatment times. So I think those could be some of the positive aspects too, or the silver lining, to the changes in medical treatment we've seen during the pandemic.
David Widener: Absolutely. Well, thanks Brian, for providing your insight on that issue.