When I woke up last Wednesday morning I had no idea I would move from Risk Management expert to liability claimant, but in the blink on an eye I moved into a new category.
To give you some background, on April 2nd, 2011 my aunt’s husband passed away, because I am her only living relative in the United States I instantly became her legal guardian. My aunt is 85 years old and has stage two dementia and multiple medical conditions that have consumed all of my non-working hours. After many weeks of working to stabilize her health, I placed her first in a nursing home and then moved her into one of the top Assisted Living Facilities in Palm Beach County. Honestly I love this facility. So my issue from this point on has nothing to do with my aunt or her care but telling you this will help you understand the context of what happened to me on Wednesday.
I spent the week of October 22nd in Washington, DC attending the SHRM Diversity Conference and the NAAAHR Annual Conference. As I customarily do when I am on an extended travel trip, I call to check with my aunt to see how she is doing. On one of my phone calls she expressed the desire to go to the hair dresser to get her hair done, so I promised that I would take her to a local hair salon when I got back to West Palm. Fact is, she was being belligerent about going to get her hair done and having to wait until I got back – but I resolved to add this to my list of things to do for her and make it happen.
On Wednesday morning I made an appointment to take her to the hair dresser at 3:30pm. I left my home travelled to the ALF entered the facility via the secured guard house, parked my car near the building that she lives in. I sat in my car for about 3 minutes finishing up a phone call and replied to a client email. I exited my car, walked up to the concrete walk-way and started walking to the building.
To further expand the context of this story, I was wearing jeans, sandals with a half-inch heal and a short sleeve shirt.
As I walked along I felt my right foot hit against the concrete, what I later discovered is the fact that the tree located immediately to the right of the walk area had infiltrated under the concrete and lifted it up just enough to snag the heal of my sandals. As I made my next step to the left all I could feel was the loss of control. With my right foot snagged and my left foot in motion, I was now headed full frontal to the concrete pavement below. Somehow instead of landing full face forward I landed on my left side. Well left side is not quite accurate; I landed on the left side of my face – directly on my cheek bone. All I felt was blood gushing from my face.
In the wind I heard a lady’s voice saying “oh my god”, let me call someone for you! Are you ok? A resident sitting on her second story balcony was watching me walk towards the building. I said to her, “I think I can get up”. At that point I managed to get to my legs and walked into the building, blood going everywhere. I felt blood in my mouth, I tasted my tooth and it felt broken and my nose was bloody. I will spare you the further gory details but thanks to the nursing staff, they cleaned me up and I managed to go up to my aunt’s apartment to get ice for my face.
My injuries:
- Large cut to the left side of my face
- Skin removed from my cheek, nose, lip, area below and above my lip, knees, hands, knuckles and finger.
- Pain in my knees, left hip and leg
- Broken front left tooth (the big one in the front – no comment!)
- Water running from my left eye. Dr says its the trauma.
- Broken glasses
The nurses applied strips to the cut on my face, cleaned up the blood and told me to go to the office. Dazed but deciding that I better do an incident report I went on my way to the main office of this facility. Keep in mind that I couldn’t walk to the main office, so I got in my car and drove over to the main building to do the incident report. When I arrived in the office, I was sent to the “Facility Manager” who promptly told me that she could not do the incident report I had to go back to the building where I got injured and the nurses who stopped the profuse bleeding would have to do the incident report. So once again I got back in my car and drove around to the place where I fell, walked back into the nursing station and filled out the incident report.
I then drove myself home – not a good idea but I did it. (Yes, 911 was an option but I didn’t want to go to the hospital on the other side of town – and I didn’t think I would die driving home) Yes, that was stupid.
When I arrived at home, my husband freaked out. He took one look at my face and said no one is going to believe that you fell, they are going to think that I hit you. You look like someone beat the “s…t” out of you. My face was now swelling and I was in total pain. I asked him to drive me to the ER and wait in the car if he felt intimidated by my injuries (men are very peculiar) but he obliged and came into the ER with me, explained to them that I fell and within minutes I was being treated by the ER for a possible concussion.
The doctor after shining a light in my eyes over and over said does your head hurt? I said, No. I feel cross eyed, a little dizzy but not head pain at this point. After observing me and asking me a million questions about the day, where I was and what I was doing – he came to the conclusion that I did not have a concussion. But he cautioned me that if I felt dizzy or had a headache or had any sudden funny issues with my vision at any point in the next 48 hours I needed to call 911. The nurse cleaned me up, because my wound started bleeding again and they applied bandage and saline soaked gauze to my wound. Doctors’ recommendation: Ibuprofen and ice for the next 48 hours. So I’ve had my initial medical treatment, I’m now on bed rest and told to avoid any strenuous activity. Technically, I’m off work! – Its official I’m now a claimant.
But this is too simple, right! Wednesday, pm I get a phone call from one of the nurses who help me. Wonderful young lady, she insisted that I go to the ER and called to see how I was doing. As that point I thought great they care!
Not so fast! Thursday morning arrived with a bang. Not only did my face swell but it swelled almost to the point of being unable to recognize myself. My lip swelled so big I couldn’t swallow from a glass. I figured, it’s now 24 hours the ALF will call me to see how I’m doing, because they care. My aunt lives there, I am there all the time and they know me personally. Wrong – Thursday came and went – no phone call.
Problem number one, I am the President of the company and a public speaker who has a full schedule almost every day. I had to explain to 4 clients that I had to cancel their training programs and I had to cancel attending and participating in an ADA Workshop hosted by the Palm Beach County Bar Association. It’s Tuesday and I am still off work because I can’t sit for more than 30 minutes without pain in my hip. I can’t be off work – for even a millisecond. For crying out loud this is my business, no work – no pay!
Friday arrives with new challenges, I can’t stand up without severe pain in my hip and half way through the day my right leg/foot is beginning to swell for no apparent reason. My face is still swollen and I am having cabin fever. I haven’t left my house in 2 days. I am in agony, so I picked up the phone and called the facility. I was directed back to the “Facility Manager” who shooed me away when I got injured on Wednesday. I got her voice mail and left a message at 9 am. The day went by – 5pm came and went – no phone call.
At 6pm, I was starving and since I couldn’t drive because my glasses were broken, in addition to the minor fact that my eyes were swollen. I went on-line and ordered Dominos’ Pizza. When the pizza man arrived at my door, I was too embarrassed to show him my face, so I put a huge towel over my head and cracked the door, grabbed my Artesian Pizza, handed him the money, said under my breath keep the change and quickly locked back the door. How would it look if I showed this man my “Mike Tyson” look? No way!
Ok so this facility has violated Claimant Rule Number 1 – Show that you care.
By Saturday morning I am fuming because I am in so much pain and I haven’t heard from anyone who gives a damn about how I am feeling. I’m moving from the understanding claimant to an angry one. Sunday comes and goes and Monday arrives. Still no phone call!
So I decided to take matters into my own hands. I made an appointment to get new glasses – off loaded $175 to get my glasses in 48 hours. Found a really old pair in my kitchen, and drove over to the ALF. I went immediately to the Executive Directors Office asked politely to see her and waited until she ushered me into her office. As I walked into her office I sensed that she was annoyed that I was there, I said to her quite politely, I want to know why you didn’t call me back on Thursday or Friday. I left a message asking for your insurance carrier information or a phone number for your claims office. I also wanted to make sure a claim was reported to your insurance carrier.
She immediately said, my legal department said not to discuss it with you. You need to go back over to the ALF building where the nurses’ station is and they will explain what you need to do next. But you are the Executive Director of this facility – why can’t you answer my questions – I’m not a stranger. (Imagine how a “stranger” would be treated)
Violation of Claimant Rule Number 2, 3 and 4:
- Rule 2 – Don’t treat the claimant like they are an idiot. Respect and a clear explanation of what the next steps are, is essential to having an open communication during the initial claims process.
- Rule 3 – Don’t tell me about your legal department. That implies that you have a team of lawyers and I need to get one now to prevent you from getting the upper hand on me. Frankly when you said legal department, I should have said, ok you will hear from my team. Doing a mental check I’ve handled 100,856 claims in the 28 years I’ve been in the claims business. (Thats on average 350 claims each month) I’ve gone up against the best plaintiff attorney’s in the Southeast. They know me by name, I know the good ones and the ones who will gorge your eyes out while having a glass of champagne – guess what they would be more than happy to take my claim for free, I’ve paid them enough money in the last 28 years. (But she doesn’t know that – yet)
- Rule 4 – Have a cohesive policy for handling incidents that happen. As all adjuster will agree, s..t will happen, how you deal with it makes or breaks the process. Don’t shuffle people from one person to the other without a clear aim or appear that you are stalling for time. This is reason number 2 to get a lawyer.
So as I left the administrators office shaking my head, really feeling that she thinks I am a fraud – I see it written all over her face (no pun intended)! I drive once again back to the nurses’ station, only to be advised that their “Risk Management Consulting Company/Legal Department” told them to tell me that if I want the claims information I have to do it in writing! Then they will send it up to the corporate office and get back in touch with me. Really?
Violation of Claimant Rule Number 5 – don’t make the claims process difficult. Call the claim into your insurance carrier, conduct an investigation if necessary and report your findings to your carrier. Your insurance information is not a secret – I can get a court order to get it if I have to. As a side bar, don’t listen to your “Legal Department” – use common sense. Oh yeah, that policy and procedure manual that you have or that’s on the proverbial shelf gathering dust. Pick it up, dust it off and figure out what’s next.
Now, I’m feeling like I should become a represented claimant who will be out for vengeance in a nano minute. Guess what, I need to go back to the doctor. My years of experience gives me a good track record on how the body works, I need therapy to stop my hip from stiffening up and on day 7 I don’t have any idea who the insurance carrier is and I don’t know who’s going to pay my mounting medical bills. Why should my health insurance carrier pay for something they didn’t cause? Furthermore, as you all know I am a public speaker. I now have a scar on my face, a broken tooth and I look like death warmed over. Not the image that I need to project as the CEO or Keynote speaker. But no one is getting this message yet.
Oh and to boot, the broken sidewalk is still there waiting for the next victim who could be an 85 year old resident. Imagine that fall and the liability suit that will follow. You think my fall was an annoyance that one will give you a nervous breakdown. (Hopefully, you are not their insurance carrier)
Claim Prevention Rule Number 6 – Daily facility inspections will catch items that are “accidents” waiting to happen. Just because it hasn’t happened doesn’t mean it won’t. If you can’t get the simplistic process of a claims report done, how are you going to master fixing several broken sidewalks in the very upscale facility? With old people who can fall on a dime!
I’m going to keep blogging – about this so stay tuned. I know this isn’t workers comp it’s liability and the rules are different – not really! A claim, is a claim, is a litigated claim!
