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COMMENTARY: Heroes deserve second look

COMMENTARY: Heroes deserve second look

Occasionally, I see a workers compensation claim denial that captures intense media attention and embarrasses an employer or insurer before they reverse their original decision not to pay.

But by the time they change course, the trouncing of the brand's reputation has been accomplished. It's usually done by several newspapers, blogs and TV news outlets chasing the story.

These cases usually make me wonder: If the insurer or employer is going to reverse their claim denial eventually anyway, why didn't they spare themselves the brand damage by accepting the claim when they first received it?

Perhaps this is too theoretical of a question without any real means for insurers, employers or their third-party administrators to evaluate claim denials up front to determine whether the media will take interest.

I haven't heard of predictive modeling for workers comp claims set up to help make such determinations, or of adjusters receiving training in media relations. And really, denial or acceptance of a claim shouldn't hinge on whether the case would make a good news story that might make a claims payer look bad.

Those decisions should be about sticking to the law on what is compensable and what isn't.

But I was reminded that the issue is worth thinking about when another one of these stories recently generated headlines for a week or longer.

You may have heard about Mark Lindquist, the group-home worker hailed as a hero for putting his life on the line in a vain attempt to save three men with Down syndrome from the May 22 tornado that heavily damaged Joplin, Mo.

He suffered extensive injuries and wound up in a coma for about two months, eventually facing at least $2.5 million in medical bills.

But his employer's workers comp insurer, Lansing, Mich.-based Accident Fund Insurance Co. of America, at first declined to pay.

The insurer cited state law limiting recovery for injuries received during a tornado to situations where the employee was subjected to a greater harm than that of the general public.

But after national media reports about the denial, Accident Fund said in October it received additional information about the claim and would pay after all.

Sure, claim denials should be based on laws applying to the specific facts of the case. And new, additional information can surface.

But if insurers or employers are eventually going to reverse their denial, might it make sense to consider a different decision before the brand damage occurs?

And here are a couple of hints for doing that:

One, media consumers love stories about heroes wronged by insurers and employers.

Two, when someone worthy of community hero status files a claim, collect that additional information before deciding whether to deny.