MEC Connect

Hosts Matt Yehling and Patty Reinecke welcome back Dan Dalton, Chief Claims and Regulatory Counsel at MEC, to discuss the resolution process for complex and high-exposure workers compensation claims. Dan provides insights into when to begin settlement discussions, the steps involved in resolving these claims, and the role of mediation in reaching a compromise.

Discussion Points:

1.       Timing and Steps for Resolution: Dan explains when to consider settlement and outlines the steps involved in resolving excess claims, from identifying issues to determining exposure and engaging the other party.

2.       Involving Defense Attorneys: MEC strongly recommends involving a defense attorney, especially on large dollar claims, to protect the employer's interests, handle paperwork, and navigate the administrative system. Dan highlights the importance of having legal representation for both the claimant and the employer in complex cases.

3.       Mediation as a Resolution Tool: Dan discusses how mediation serves as an alternative dispute resolution process that brings parties together to reach a compromise. He explains that mediation is particularly effective for claims with disputed issues and high exposure, where a neutral mediator helps the claimant, their attorney, and the employer's representatives find middle ground.

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Hosts Matt Yehling and Patty Reinecke sit down with Vicki Barker, Senior Claims Analyst for at MEC, to discuss success stories and the positive impact MEC has made on injured workers’ lives through their handling of complex workers compensation claims. Vicki shares her perspective on measuring success, collaborating with partners, and achieving positive outcomes for all parties involved.

Discussion Points:

1.       Defining Success: Vicki explains that success in excess workers compensation claims is measured by making a difference, regardless of the size of the impact, through new perspectives, ideas, information, and resolution strategies.

2.       Collaboration and Addressing the Opioid Epidemic: Vicki emphasizes the importance of collaborating with all parties involved in a claim and discusses how MEC assists partners in identifying and mitigating opioid usage while prioritizing the well-being of the injured worker.

3.       Impact Story: Vicki shares the inspiring story of a police officer who, despite being shot and rendered semi-quadriplegic, received comprehensive support from MEC and went on to become a consultant for his department and a hometown hero.

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Hosts Matt Yehling and Patty—Reinecke are joined by Gina Holt, former Client Consultant Manager and current ISI Underwriter at MEC, to discuss how MEC collaborates with clients and TPAs to mitigate costs on complex, potentially excess-level workers compensation claims. Gina shares insights on MEC's hybrid role, early intervention strategies, and leveraging internal resources to improve claim outcomes.
 
 Discussion Points:

1. Early Intervention and Collaboration: Gina emphasizes the importance of early intervention and collaboration among MEC, clients, and TPAs to prevent medical costs from compounding. MEC's team reviews claims to identify red flags and provide mitigation strategies.
   
   
2. Managing Excess Claims: Gina outlines the key components of successfully managing an excess claim: communication and trust. MEC takes a holistic approach, engaging their resources to develop mitigation strategies in collaboration with the TPA and defense attorney.
   
   
3. Connecting with Injured Employees: Gina shares an example of how MEC's interventions, such as medication reviews, can significantly improve an injured worker's quality of life by addressing issues like over-medication and helping them return to a more functional lifestyle.

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Hosts Matt Yehling and Patty Reinecke are joined by Marianne Reed, Senior Claims Analyst at MEC, to discuss strategies for containing and mitigating costs in complex workers compensation claims. Marianne shares her expertise on identifying cost drivers, collaborating with stakeholders, and implementing targeted interventions to improve outcomes and reduce expenses.

Discussion Points:

1. Cost Drivers in Complex Claims: Marianne outlines the medical treatments that tend to be the biggest cost drivers in complex claims, such as injections, brand name medications, spinal cord stimulators, and failed surgeries. She also describes the typical features of these claims, including multiple surgeries, psychological issues, and long-term opioid use.
   
   
2.  Strategies for Cost Containment: Marianne shares her approach to mitigating costs, which involves reviewing medical records, engaging MEC's resources, collaborating with stakeholders, and implementing targeted interventions like medication reviews and negotiated rates.
   
   
3. Successful Claim Intervention Case Study: Marianne provides an example of a catastrophic claim where early intervention by MEC led to a successful outcome. 

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Hosts Matt Yehling and Patty Reinecke sit down with Dr. Fernando Branco, MEC's Chief Medical Officer, to discuss Complex Regional Pain Syndrome (CRPS) and Reflex Sympathetic Dystrophy (RSD). Dr. Branco shares his expertise on these challenging diagnoses, explaining how they can develop from seemingly minor injuries and the difficulties in accurately diagnosing and treating these conditions.

Discussion Points:

1. Sprains and Strains Progressing to CRPS/RSD: Dr. Branco explains that it's common for minor injuries like sprains and strains to progress into CRPS or RSD, especially in the excess claims world. He notes that increased awareness of these conditions has also led to potential overdiagnosis.
   
   
2.  Diagnosing CRPS/RSD: Dr. Branco emphasizes the importance of a thorough physical exam and following established diagnostic criteria. He discusses the role of temperature measurements, sweat tests, bone scans, and sympathetic blocks in the diagnostic process.
   
   
3. Treating CRPS/RSD: Dr. Branco outlines a treatment approach that includes sympathetic blocks, aggressive physical therapy with desensitization techniques, cognitive behavioral therapy, and medication management. He stresses the importance of an experienced, multidisciplinary team and cautions against overreliance on invasive treatments.

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This episode features guest Tina D'Andrea discussing the critical topic of post-traumatic stress disorder (PTSD) in the workplace. With over 25 years of experience in workers compensation, Tina offers deep insights into the symptoms, diagnosis, and effective treatment of PTSD, particularly among professions with high public interaction like first responders, medical personnel, and teachers.

Discussion Points:

1. Understanding and Diagnosing PTSD: Tina defines PTSD and outlines its common symptoms, such as intrusive thoughts and hypervigilance. She elaborates on the diagnosis process, highlighting the CAPS-5 test and the PTSD Checklist as critical tools for accurately identifying the disorder.
   
   
2. Effective Treatments for PTSD: The conversation shifts to treatment strategies, with a focus on cognitive behavioral therapy, group therapy, and the potential use of medication. 
   
   
3. Navigating PTSD in Workers Compensation: Tina, Matt, and Patty tackle the challenges of managing PTSD claims within the workers compensation system, stressing the need for specialized care and the difficulties associated with psychological injury claims. A success story is shared to illustrate the positive impact of appropriate and timely treatment.

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Hosts Matt Yehling and Patty Reinecke are joined by Jeff Pack, a Medical Management Consultant at MEC, to discuss failed back syndrome. Jeff shares his experience dealing with complex back injury claims that often start as sprains or strains but can lead to multiple surgeries and the diagnosis of failed back syndrome. The episode explores common trends in these cases, potential interventions, and advice for managing claims involving failed back syndrome.

Discussion Points:

1. Sprains and Strains Leading to Excess Claims: Jeff explains how many back injury claims that reach the excess layer at MEC begin as sprains or strains but progress to surgeries, sometimes multiple, before arriving at a failed back syndrome diagnosis. He shares examples of cases involving a nurse and a mechanic to illustrate this progression.
   
   
2. Common Trends and Potential Interventions: The discussion covers common back injury diagnoses seen in the excess world and potential interventions to prevent failed back syndrome. Jeff highlights the importance of addressing problems quickly, finding physicians aligned with the goal of returning employees to work, and considering tools like nurse case managers and second opinions.
   
   
3. Risks and Complications of Spinal Cord Stimulators: Jeff delves into the risks and complications associated with spinal cord stimulators, which are sometimes presented as a "golden ticket" for pain relief in failed back syndrome cases. He emphasizes the need for thorough consideration and second opinions before proceeding with these devices.
   
   

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Hosts Matt Yehling and Patty Reinecke welcome Dana Dorsey from MEC's Medical Management Unit to discuss sprains and strains. Dana, with her extensive background in field case management, dives into the definitions, treatments, and prevention of these injuries, highlighting how they can lead to complex claims if not managed properly from the outset. The episode focuses on practical advice for both employers and employees to handle and prevent these injuries effectively.

Discussion Points:

1. Defining Sprains and Strains: Dana explains the differences between sprains, which involve ligaments, and strains, which involve muscles or tendons. She outlines the symptoms, severity grades, and recovery processes for these injuries, providing a clear understanding of their impact.
   
   
2. From Simple Injuries to Excess Claims: The discussion addresses how injuries that initially appear as sprains or strains can develop into more severe conditions, leading to significant claims. This segment underscores the critical role of early and accurate diagnosis in managing these injuries.
   
   
3. Strategies for Prevention and Early Intervention: Highlighting the importance of preventive measures, Dana discusses ergonomic improvements, proper training, and early medical intervention. This part of the conversation emphasizes actionable steps employers and employees can take to minimize the occurrence and severity of sprains and strains in the workplace.

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They explore key differences from catastrophic claims, focusing on disputed issues, medical care management, and disability assessment. Dan shares insights on the use of Independent Medical Examinations (IMEs) and emphasizes the value of involving opposing counsel. The episode highlights the need for a collaborative approach to improve outcomes for injured employees. 

Discussion Points:

1. Investigating Migratory Claims: Dan explains the key differences between migratory claims and catastrophic claims, highlighting the importance of identifying disputed issues, managing medical care, and addressing disability in migratory claims.
   
   
2. Effective Use of Independent Medical Examinations (IMEs): Dan offers insights into the strategic use of IMEs, emphasizing the need to consider their purpose and potential impact before proceeding.
   
   
3. Collaboration and Communication: The episode underscores the value of collaboration and open communication among all stakeholders, including defense counsel, to navigate complex migratory claims and achieve the best possible outcomes for injured employees.

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In this episode of MEC Connect, hosts Matt Yehling and Patty Reinecke sit down with MEC Senior Claims Analyst Kam Garrett to delve into the complex world of migratory claims. Kam shares a real-life example of a migratory claim that spanned over a decade and the challenges involved in handling such cases. They also discuss recurring trends, resources, and strategies for managing migratory claims effectively.

Discussion Points:

1. Real-Life Example: Kam provides a detailed example of a migratory claim that took almost 13 years to resolve, emphasizing the persistence required in managing such cases.
   
   
2. Challenges in Handling Migratory Claims: Kam highlights the unique circumstances and evolving treatment plans associated with migratory claims, including prescription complexities, financial considerations, and posturing for settlement.
   
   
3. Impactful Resources at MEC: Kam discusses the resources available at MEC, such as preferred pharmacy benefit management, experienced medical teams, cost projections, and structured settlement brokers, to help navigate and reduce costs in migratory claims.

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