Pete and Repeat
By John A. Shega
Owner-Aspire Insurance Agency
johns@aspireinsurance.biz - 952-891-5864
This week, two separate but related incidents reminded me why workers compensation is
perhaps my favorite line of insurance. That’s because workers compensation deals with
human beings at their best and, unfortunately, at their worse. As always, I am using factual
situations but changing the specifics to ensure the situations remain anonymous.
Pete is a long-term, high performing and valuable employee. That’s how his employer
describes him. Pete on the other hand, views himself as an older, overweight employee with
non-transferable skills. He is very worried about the economy and his chances of finding
another job should he ever be laid off. Last month and for the first time in his 18 year
employment career, he hurt his back at work. He initially shrugged off the injury as “no big
deal” but the pain became intolerable during the weekend. Not wanting to miss work on
Monday, he went to the emergency room on Sunday. The Dr. asked how he hurt is back and
Pete replied, “shoveling snow’. The Dr. prescribed pain medication and Pete went home to
rest and worry. He reported to work on Monday with significant pain. His supervisor noticed
Pete’s pain and asked what’s wrong. “Nothing that won’t go away”. It doesn’t go away, Pete
doesn’t have health insurance, and he knows it won’t get better without rest and medical
help. He fearfully tells his employer the facts. A first notice of loss is turned in. Pete remains
terrified of being terminated because of the claim so he tells the adjuster “I’m not 100% sure
if I hurt it at work” during the phone screen. The adjuster compares Pete’s “I’m not sure”
answer to the “shoveling snow” he gave to the Dr. and correctly declines the claim as it is not
work-related. Only after Pete is assured he cannot and will not be terminated because of a
legitimate work-related incident does Pete correctly convey the facts and secure coverage
under workers compensation. Everyone is pleased with the outcome.
Repeat is the exact opposite of Pete in many ways. He is rather new employee (1.5 years),
fresh out of college, attractive, articulate and believes finding another job would not be
difficult. In fact, he is always “looking at his options” because he believes he is underutilized
and under paid. His supervisor considers him a marginal employee with “attitude issues”.
I made a routine visit to the employer and a supervisor asked if anything could be done with
“repeat offenders”. I clarified the question and then we agreed that I would complete a “trend
analysis” of the work comp claims. Sure enough, Repeat caused 92% of all claim costs and
he is less than 10% of the employee population. All of his claims where questionable and
most were called in on a Monday (red flag). Repeat’s unacceptable behavior and attitude
should be dealt with. Termination, if appropriate, must be reflective of his work-related
issues and not because of his work comp situation.
Closing. Workers compensation exists to assist employees that are hurt at work. Employees
cannot be terminated solely because their work comp experience. They can, however, be
terminated if there are other mitigating factors that deem the employee an unsatisfactory
employee. Pete should not have had to fear turning in a legitimate claim; Repete should be
terminated as quickly as legally feasible. As always, proper job descriptions, performance
management, documentation and communication are imperative to ensure proper compliance
and legality. Need help? Call us. You can manage your insurance costs.