To be honest, this post doesn’t have much to do with Star Trek. Ok, it has nothing to do with Star Trek, except for a clever play on words designed to suck you in and take you along for a joy ride of erudition.
Or not. Whatever, you’ve come this far. Might as well slug your way through the rest of this morass.
The movie “Star Trek II: The Wrath of Khan” featured a genetically enhanced evil character presumably incapable of dying, as he was also portrayed in the original Star Trek series almost 20 years prior – and in that episode was already more than 2 centuries old. Khan Noonien Singh was played by Ricardo Montalban, whose acting career ironically was also more than 2 centuries old and seemed equally incapable of dying. Anyway, long story short, Starship Enterprise Captain James Kirk pisses Khan off in 1967 by preventing his takeover of the universe, and in 1982 he returns with an unequivocal wrath to destroy a planet and get even with Jim Kirk in the process.
Wrath, thy are a hard and heartless bitch.
It is at this point of the story where I dust off my trusty virtual rubber mallet and bang this bad boy into something that resembles a blog about workers’ comp. Here goes:
Star Trek had the wrath of Khan. Workers’ comp has its very own nemesis, the wrath of “can’t.” Wrath is a dangerously powerful emotion, and the use of “can’t” is likely one of its biggest originators. Can’t, in workers’ comp, is one of the principal drivers of friction, anger, litigation, and cost.
You can’t get a second opinion.
You can’t go outside your restrictions.
You can’t go back to your old job.
You can’t choose your surgeon.
You can’t have control over critical life decisions.
You just, well, Can’t.
The problem is, in workers’ comp, Can’t is often unavoidable. Statutorily, there are many ways to encounter the word. Employer and carrier policies as well can be problematic for the adjuster in the trenches, trying to navigate the labyrinth of complexities that surround a typical comp case. In cases where Can’t is an inescapable certainty, the key to minimizing wrath is often found in how we convey the message. We must remember that the word Can’t is going to affect someone’s life and potential well-being. We need to respect that reality when the message is delivered.
Or, sometimes, we preferably can find creative ways to circumvent the situation and avoid the word altogether.
I had a conversation this week with a claims professional who will be part of a panel I am moderating this summer at an upcoming conference. We discussed the challenges and limitations adjusters and other claims professionals encounter in their everyday work. One of the things we touched on was circumventing policy when it meant better results for all involved. That included convincing a carrier or employer to pay for a procedure that might normally be denied if the outcome could mean better results and shorter injury duration. It may be convincing the paying entity that exceeding statutory requirements just might be in their best interest in the long run. It means that Can’t does not have to be an absolute result if people think outside the box and work to communicate the benefits of saying yes, we can.
After all, the word “Can” does not produce nearly the litigation and expense that the word “Can’t” does. We need to remember that, especially if we want to focus on the longer goal of better outcomes for all involved (except, maybe for attorneys – financially they thrive on the word Can’t as well as its close relatives, Won’t and No).
Captain Kirk, it turns out, was lucky. Khan’s ego and inexperience with three-dimensional space combat ultimately led to his demise. It took a couple of centuries plus a couple of decades more, but they were finally able to put that arrogant bastard down (of course they also killed Spock in the process, but he was under contract for another movie, so they had to bring him back). Unfortunately for workers’ comp, Can’t is much, much more resilient. It will be harder to put down than a genetically enhanced tyrant from the eugenics wars. But it can be controlled, and the wrath it generates minimized, if we are willing to understand its impact and work to minimize its use.
What a great way to start the day.
Thanks, Mike. Great to hear from you!
My Utilization Review manta (which I’m working at on a continuous basis) is “if we’re saying no, there needs to be a good reason”. The claims team I work with does a really good job of recognizing instances when we should and do override a UR denial. My parents were both injured workers so I try to ask myself if I’d be comfortable denying a particular modality if they were the patient. While I’m sure there’s room for improvement, I’m constantly working to find the balance between what should and should not be approved.
Grawlix! Your word play was stronger than a tractor beam at pulling me in. (Big surprise, I know.) In spite of your deception, I agree with your points. I have worked on several “exceptions to policy” in order for workers to receive what they need. Rules (and torpedoes) be damned! That is central to the worker centric model and it prevents work disability.
I have always wondered if Khan’s cryogenic capsule had a tanning lamp. Just saying . . .