Workers Comp Return to Work Keynote by Margaret Spence

Good morning, everyone. Thank you so much for inviting me to Ohio. Thank you to the BWC. I want to say before I start my presentation that sometimes when you're in the throes of workers' comp, you're not always getting recognition for what you're doing, and sometimes we don't pat ourselves on the back enough. And we don't say, you know, we're really doing a great job. So I want to just say to you, I speak all over the country, and one of the things that I try to do is customize my presentations to the groups that I'm speaking to. And as I researched, um, what was going on here in Ohio, I came to realize that you are actually on the cutting edge of a lot of things. You're one of the few incentivizes employers to bring injured workers back to work. That's unique. The system that is created is injury, settle, goodbye, have a good life, start over somewhere else. So I want to commend the Ohio Group for doing that. The other part that I thought was extremely unique was the fact that you're now adding wellness. As a key component of the workers' comp process. So I think sometimes we don't always pat ourselves on the back, but I think that those two things are actually very unique for Ohio and something that you as a group, as a Board of Governors that are managing this program, should really commend yourself on doing that. Having said that, um, I want to tell you a little bit of a story, and I'm always talking stories, and I want to give you a sense of how I arrived at the return-to-work table, what brought me here, and an experience that I had earlier this year that also— that all confirmed a lot of my feeling. For years, I sat in an adjuster's desk, and as I sat in that adjuster's desk, I got a call from an employer, and I would say to the employer, well, you know, can you bring the injured worker back to work? Can you find a job for them to do? And every single time I would get this, "Well, you know what, I don't think there's anything that the employee can do." And I started thinking, how could there possibly be nothing that they can do in your work environment? How is that even possible? And as I sat there, I realized, you know what, there's got to be a better way. One of the key challenges that I had when I arrived at the Palm Beach County School District and I started managing claims for the district. I walked in, my boss hired me, and she said, Margaret, I have a surprise for you. I have a gift. And I said, really? Oh my gosh, I've never been hired anywhere where somebody's given me a present. And I walked in and she showed me a room and she said, Margaret, these people have been injured for years and they've never come back to work. And I said, what are you talking about? Well, guess what? There were claims in that room that had been there since 1957. We had people who we were paying permanent disability to who had gone out on permanent disability at the age of 21. We had people who we were paying permanent disability to who had gone out of the system at age 25 and 30. Several of those claims were open longer than I had been born. And for me, I was like, are you kidding me? I can't believe that this is a reality. But I had a boss who was a visionary, and she said to me one morning, Margaret, we are going to create a return to work program program here at the district, and people are not going to like us. In fact, they're going to hate us. So I want you to get comfortable with people not liking you. And I thought, okay, um, this is interesting. I've never been on the most hated list before, but I'm sure I'll get accustomed to it. One of the challenges that we had at the district was bus drivers. Because they didn't get paid in the summertime, they got injured in January and they were light duty January, February. March, suddenly they went back to the doctor, and in April they got an off work. So we paid them for the summer. Then we had a policy where we automatically paid the first 30 days of the injured worker being off work. So for 30 days you could sit at home with the right note and you could stay there. The other challenge that we had was the physicians that we— that treated our injured workers were given a pass. We really never stopped to evaluate the physicians that treated our injured workers. It was easy for us to just rubber stamp whatever the doctors did. And I'm not blaming the doctors, and I want you to understand, I'm not saying that they were doing a bad job. What I'm saying is that we never challenged them to think anything other than off work. We never challenged those doctors to say, what can the employee do? We got very, very, very comfortable accepting what the employee could not do. And we based our entire program around the employee's inability, and we never, ever, ever focused on the employee's ability. So in essence, what happened was that 80% of our workers never came back to work. Once they got injured, we found ways to make them disabled. Our system was created in that manner. 4 years into the cycle of working with the district, we cut our claims load in half. We returned almost everybody to work, and I began to see that it was doable. We created a system of accountability, and we created a system of ability. And so I know firsthand not from guessing, not from estimating. I know firsthand that return-to-work programs work, that they're very possible, that they can be done. But one of the things that I know also is that it doesn't happen unless you create a tribe of believers. You have to create a tribe of believers. You have to slowly build your island with a bunch of people on it who believe in what you're doing. And when you build a tribe of believers, you actually can make the change happen. So that is the first part of what I wanna say to you. The second part of what I wanna say to you is I've actually been a claimant. Surprise, surprise. November the 2nd, 2011, I was walking to a client location, and I fell. Um, through no fault of my own, I actually fell, and I hit the concrete so hard that I actually broke my glasses, broke my tooth, um, and was severely hurt. And for the first time in almost 30 years that I handled claims, I got to see what the injured workers go through. And so my concept, my perception has changed. I want to tell you that we have a system that doesn't always work for the injured worker. Let me give you the conversation. I didn't necessarily want to file a claim, but when I called my office manager, she said, "Are you kidding? You need to file a claim." So I did, and I got a very young adjuster on the phone, and I explained to her what happened, and I said, you know, I really don't want to file a claim. And she said, really, you need to file the claim. So I did. I did the notice of injury. I did the whole nine yards. And one of the things that immediately I felt, because of the way that the adjuster talked to me on the phone, I started feeling that I needed to justify my claim, because she made me feel like I needed to justify my claim. She said to me, "Are you sure that body part hurt?" And I thought to myself, okay, I hit the concrete. What part of that aren't you getting? And then she said, "Well, how did your right foot hurt when you hit the left side?" And I started feeling my defenses being built. Then I began to see the process of getting access to medical treatment. The first doctor said, "Oh, there's nothing wrong with you. You don't need physical therapy." And I thought, you know, "Are you kidding? I do this for a living. I know the deal. I've sent enough injured workers through the system. The process is you get me medical treatment immediately." So 6 weeks later, when I was waiting for the physical therapy authorization, I realized that the system is also broken. So today what I want to present to you is the side of making it work. How do we build a tribe of people who make return to work the best thing that we can accomplish? How do we take a system that doesn't always understand the injured worker's point of view, doesn't always understand the employer's point of view? How do we get everybody on the same team creating a dynamic program that the end result is keeping employees feeling productive, keeping them feeling that they can contribute to their success, and continuing them to work. You know, I read a study that we spend 80% of our time at work, and work actually defines us. So I think as a system, we need to stop defining injured workers in the view that they cannot and start defining them in the view that they can. I wanna ask you a question. Do you believe in what you do? How many of us truly believe in what we do? And when I say truly believe, Do we get up every day thinking that we can make a difference for an injured worker, or do we get up every day thinking that we're gonna do some paperwork and we're gonna keep this moving?