Miracles occur daily, the impossible takes

a little longer.National Workers’ Compensation Summit 2014

Seemingly impossible claims• Really referring to seemingly impossible cases

• Difficulty in moving the case forward

• Difficulty in closing out a case

• Difficulty in having a logical conversation with the client

• Difficulty in reaching logical outcomes and agreements

Due to the injured worker being a

‘high demand’ client

For the majority of clients…• You can hold a rationale and logical discussion with

them

• They may experience difficulties at first in accepting theinjury, how it happened, new limitations etc but overallthey remain positive, optimistic, confident and conformto the process

• They generally take on board your instructions, receivefeedback without drama and are conscious of theirbehaviours & emotions in their interactions with you

For the majority of clients…• You are managing a workers’ compensation claims

process and RTW process

• You are managing a ‘change’ process

• You make gains by providing clarity in informationand structure

• You make gains by working with concerned and sometimes stressed injured workers using a

‘CALMED’ response

‘CALMED’ ResponsesEach step applies to Claims Manager & Injured Worker

C CALM

A ATTENTION & ANALYSIS

L LISTENING & LEARNING

M MIRROR

E EVALUATE

D DOCUMENT

• http://www.youtube.com/watch?v=5ePYet3Fbts

CALM (Keeping both parties calm)

• Claims Manager can role model being calm

• Moderate and consistent tone of voice

• Moderate pace in speaking

• Deep and rhythmical breathing

• Sit back in the chair, relaxing of shoulders

• Non threatening, non confrontational, non judgemental language – responding logically not

reacting emotionally

ATTENTION & ANALYSIS

• Ask questions that lead the worker to give themselves and you better clarity on the issue or concern

• This gives you information to assess the issue, assess their emotional levels and design a response

• Focus on the types of questions being asked and the language being used

• Strategies designed to help the worker pay attention

LISTENING & LEARNING• H – humour if suitable

• E – empathy

• A - attention

• R – respect

• This approach helps the injured worker to feel listened to, understood and upholds their dignity

• Look for own learning in every conversation/interaction

• Support learning for the injured worker

MIRROR

• Can the injured worker mirror back to you the salient or important points of the discussion?

• Check that the injured worker understands and can repeat back what you have just covered.

• Can you mirror back the important points the injured worker was trying to convey to you?

EVALUATE

• If the injured worker does not show satisfactory understanding, inform them again

• If required, use a different approach or different explanation

• If they still don’t understand start the process again. There may be a different issue that hasn’t been identified

DOCUMENT

• As required

• Encourage the injured worker to write down and record steps that will support them to follow through on the actions they are required to implement

For ‘High Demand’ workers• Do not adapt to the changes they face

• Insistent and demanding behaviour

• Impose power and control

• Minimal self awareness of behaviours and emotions

• Difficulty accepting injury and subsequent loss

• Blame others

• Depend on others

• Lack of insight into problems or cause/effect

• Lack of logical argument

Reasonable injured worker

• Appropriate level of emotion

• Works through loss and grief

• Able to follow the process, sees benefit in the process

• Welcomes RTW support

• Able to engage in logical discussions

• See perspectives

• Offer/participates in solutions

Maladaptive Personality Traits

• Appears reasonable but over time shows a pattern of unreasonable behaviour

• Inappropriate levels of emotional response

• Exaggeration

• Some distortion in logic

• On their own cannot easily see different perspectives or solutions

Personality Disorders• Distorted and exaggerated reaction to negative

feedback or negative situations

• Repeated pattern of unreasonable behaviours

• Cannot be persuaded

• Highly defensive, hypersensitive to perceived threat

• Chronically distressed

• Seems not to move through grief or loss process

• Dysfunctional interpersonal skills

• Depends on others to resolve the situation but doesn’t want to implement solutions or follow instructions

High Demand Workers

• Top 5 types of high demand injured workers fit into the following clusters of Personality Traits or Disorders :

- Borderline

- Narcissistic

- Antisocial

- Histrionic

- Paranoid

American Studies

• 14.8 – 21.5% of Adults surveyed meet the diagnostic criteria for at least one personality disorder

- Borderline = 5.9%

- Narcissistic = 6.2%

- Antisocial = 3.6%

- Histrionic = 1.8%

- Paranoid = 4.4%

National Institute of Health, Institute of Alcohol Abuse and Alcoholism 2001 – 2005

Journal of Clinical Psychiatry, 2004/7, 2008/4, 2008/7

Borderline Personality Traits• Very charming, very believable, will initially praise you

• Looking for emotional bonding, wanting more from the Claims Manager than can reasonably be expected

• Will ask you questions that manipulate you

• Claims Manager will start to feel manipulated and suffocated by clinging and persistent behaviours

• When the process stalls, things don’t go in their favour or the Claims Manager starts to pull back from the openness/informality in the relationship, there is intense anger and mood swings

Narcissistic Personality Traits• Will comment on and refer to knowledge or status

items that indicate superiority over others

• Talk positively about/to powerful people but can be quite rude and disrespectful towards people ‘lower down the chain’

• Will want special treatment and privileges

• Will want only a senior Claims Manager or higher to manage their case

• Appear arrogant and aloof

Antisocial Personality Traits

• Disregard for law, processes, rules etc

• Constant lying even when this is pointed out to them

• Lack of remorse for lying and for inappropriate actions and behaviours

• Can easily justify their actions

• Obsessed with dominating others

• Can be dangerous

Histrionic Personality Traits• Dramatic and theatrical

• Expand and exaggerate

• Will avoid detail when questioned

• There will be a grain of truth in what they say

• Want to be the centre of attention

• Appear to want someone to believe them to help direct and take charge for them (but will then blame that person)

Paranoid Personality Traits

• Fear of trusting someone

• Fear that they will be exploited

• Constantly bringing up doubts about the process and people involved in that

• Misinterprets ordinary events as being negative towards them

• Will often verbally ‘attack’ , belittle someone believing the other person was going to do that first

• Most likely to want to sue

In common….

• Can come across as quite charming and believable

• One can be mislead by their charm, their pain, their stories

• They seek negative advocates to confirm their internal stories and to comfort, support and defend them

• The issues they ‘throw’ at you to address and resolve are not the issues and not yours to resolve

• They have a very much heightened sense of fear

• Not very good at problem solving or envisaging the future

In general…• A Claims Manager doesn’t realise they are working

with a High Demand injured worker until they have become ‘too involved’ and too caught up in their story

• By that time, the Claims Manager will have set up interactions which aren’t conducive to good management of the person or the situation

• The High Demand injured worker now has set expectations for how the Claims Manager will interact and what they will do for them

• Breaking these expectations causes more grief for everyone

The approach to take• For High Demand injured workers, their injury is often not

the issue. Their perceptions and distortions create issues – a bit like lighting spot fires that the Claims Manager becomes busy trying to put out rather than being able to focus on the real issues and get their job done

• Learning to ignore the spot fires

• Focus on the process and task at hand

• Recognise their sensitivity to perceived threats

1) Calm them at the beginning of every interaction

2) Then move them into a more logical state with a BRIEF conversation

1) Calm• Be calm

• Speak in a calm, confident, assertive manner

• Keep tone of voice & pace of delivery moderate & even

• Do not respond to personal attacks

• Do not threaten the injured worker (ultimatums etc)

• Look to offer restricted choice

• Don’t argue

• Don’t judge or give negative feedback

• Don’t make personal comments

1) Calm – use E.A.R.

• Show empathy

• Acknowledge what they tell you about how they are feeling, where they are at, how they are coping etc

• Not showing empathy and attention will heighten their fear of abandonment or loss of attention or loss of importance etc.

• Pay attention to what they are saying – repeat, rephrase, ask appropriate questions and pay attention to what you are saying in response

• Respect their humanness, their burden, their dignity

2) BRIEF conversations

B BRIEF

R RHS CONNECT & RESPECTFUL

I INFORMATIVE & INSTRUCTIONAL

E EDUCATE

F FIRM

BRIEF

• Keep the conversation brief

• Know the objective/goal/purpose for the conversation and stick to it

• Long explanations and responses to spot fires opens up loop holes for other aspects/issues to enter into the conversation

RHS & RESPECTFUL

• This is a reminder to connect with the ‘RHS of the brain’ concept for the injured worker (Staying calm, using E.A.R.)

• Not starting with a logical conversation

• Go through a brief E.A.R. process then move into a logical conversation

• A reminder not to trigger a threat response

• Be respectful – don’t raise your voice, don’t respond to attack

Concept of the LHS / RHS• Left hand side

• Verbal language

• Logic

• Writing & Reading

• Listening

• Calculations

• Analysis of parts

• Sequencing

• Linear thinking

• Sees cause and effect

• Right hand side

• Non verbal

• Creativity

• Arts

• Kinaesthetic

• Emotions

• Music tunes

• Holistic & Intuitive

• Responds to words as images

INFORMATION & INSTRUCTION• Focus on task and process

• Do not focus on emotions, arguments, reactions

• Focus on the provision of information and/or instruction

• Focus on facts related to the purpose of the call and for resolving the claim

• Do not focus on what the injured worker puts forward as fact that is not related to the process or situation at hand

• Move worker to using ‘LHS of the brain’ concept by getting them to list, rank, prioritise, sequence

EDUCATE• Confirm and reaffirm roles, responsibilities, process

• Educate the injured worker as to what your professional boundaries are

• Educate the injured worker that it is their responsibility to make decisions, make bookings etc and your responsibility to explain steps and processes

• Educate the injured worker about consequences that flow from actions or inaction

• Educate yourself to become more cognizant of your emotions, reactions, stress levels and how to pick up early on patterns of behaviour

FIRM• There is no need for apologies or a passive/soft

approach

• Present with a firm but fair and assertive approach

• Be firm with setting boundaries

• Where the conversation is going in circles, repeat the necessary information and close the conversation

• Be clear about next steps including their responsibilities and next opportunity for communication

(A high demand injured worker will expect the claims manager to be available all the time)

SUMMARY• First connect with E.A.R. then move into logical discussion

• Focus on process and structure

• Respond to misinformation that is relevant and impacts on the claim process

• Do not respond to misinformation or exaggeration that is not relevant

• Set professional boundaries

• Set limits for behaviour

• Set limits for contact

• Look for the truth & acknowledge the injured workers strengths

• Use BRIEF

Trust your senses but don’t react. Often what we feel like doing with claims

involving high demand injured workers is counter intuitive - escalating and not resolving seemingly impossible claims.

Workplace Conflict Resolution

• 1300 227 901

• enquiries@wpcr.com.au

• www.WorkplaceConflictResolution.com.au

Reference:

• Eddy, B. ‘High Conflict People in Legal Dispute’ 2009