Matching Cultures to Claims
workers with claims
and case professionals
of similar backgrounds
that delay recovery.
By Susannah Levine
Want to keep your workers’ compensation claims from sliding off the rails? Start with case managers and claims adjusters who look, think and talk like their clients. Four years ago, Travelers started its Cultural Advantage program. The program hires Hispanic adjusters and nurse case
managers to more closely mirror the populations it serves. The initiative produced
a 24 percent improvement in injured workers returning to work within 30 days
and a 23 percent reduction in attorney representation, said Chris Nixon, senior
vice president, claim field management, Travelers.
Often, he said, the conversation begins in English, and as the rapport develops,
the injured worker or case manager will ask, ‘Do you speak Spanish?’ “When the
response is ‘Yes,’ the conversation transitions into Spanish, and the connection
flows from there.”
In Travelers’ Southern California office, a third of claims and case professionals
are bilingual, he said, and most speak Spanish, but the program seeks to establish
“a cultural connection beyond simple language translation” by matching case and
claims managers with injured workers from a similar language and culture.
“Sharing a background provides a more personal connection,” he said, which is
a “key to establishing sincere upfront trust.”
ALL ABOUT TRUST
The success of a claim depends on trust between the client and case manager,
said Jose Alejandro, director of care management, UC Irvine Health and
president-elect, Case Management Society of America. In his 25 years in health
care, he said, “claims seldom go to litigation when that relationship is trusting,
open and collaborative.”
Trust depends on common language and cultural understanding, if not actual
common culture, Alejandro said. If a case manager or claims adjuster tells an
injured worker “these are the three things I need you to do,” he said, that command
— an emotionally neutral statement when the case manager and injured worker
understand and trust each other — could be received as officious, bullying or
arrogant if issued without medical context or regard to cultural considerations.
The worker, offended and confused, could refuse to cooperate. “What should
be quick and easy could then take a long time and use a lot of resources.”
Darrell Brown, chief claims officer, Sedgwick, breaks down what “trust” means
in the workers’ compensation context. “Manage expectations about the process
and how long it will take. Establish what to expect from the client and what the
client can expect from us. Understand the family’s needs.”
Which means, he said, address the urgent financial and logistical worries
during convalescence: How will I pay the rent? Buy food? Make car payments?
Get the kids to school?
Those concerns can be overwhelming, especially for people who already feel
marooned in a strange and perplexing world where they don’t speak the dominant
“Nurse case managers and claims
examiners need to be able to hold clients’
hands through the process, navigating
around barriers and interpreting the
strange rules,” Brown said.
Alejandro, who holds a nursing
degree and was once a claims manager
himself, recalls when his own Hispanic
cultural experience rescued a two-year-old workers’ compensation claim for a
burn to the claimant’s hands and arms.
The claim had exhausted all appeals
— and the multiple claims managers
• Pairing injured workers with
people of similar culture builds
trust faster and speeds recovery.
• Hiring a translator isn’t enough
because cultural differences
• Building trust with a cultural
connection can significantly reduce
“[Good diversity training] sets
the expectation that groups are
different, that you can’t expect
a good outcome when you treat
everyone the same. A broken
leg isn’t just a broken leg.”
— Jose Alejandro, director of care management,
UC Irvine Health and president-elect, Case
Management Society of America
Injury outcomes can be positively impacted by connecting injured workers with providers who have a shared cultural experience.