When I get a new referral, the first thing I do is call the adjuster for file direction. That call tells me what the adjuster needs.
On this call, the adjuster gave me her take. The injured worker was angry. She’d be difficult to work with. And she wasn’t following her treatment.
Her name was Grace. She was 16. She worked in fast food, and she had cut her finger during prep work.
The adjuster had her reasons. Grace wouldn’t answer phone calls, and she didn’t make any. When she did respond, it was by text, in all caps.
If you’ve ever received a text in all caps, you know how it reads. It reads like yelling.
I texted Grace to remind her of her doctor’s appointment. She didn’t come.
I texted her before the next one. She didn’t come.
Unanswered calls. Texts that shouted. Two missed appointments. Everything in the file said the adjuster was right.
An empty chair sits in a quiet medical exam room.
The third time, Grace was there.
She was sitting with her mother. Before either of them said a word, I could see it. Both of them were frightened, with worry in their eyes.
We talked for a while before we talked about anything that mattered. Then the questions came, the same questions anyone would ask.
“Will I lose my finger?”
“How am I supposed to work?”
Then Grace told me something she had never told her doctor.
She didn’t have the money to buy supplies to change her dressing. She didn’t have the money for physical therapy. She didn’t have the money for her doctor’s appointments. And she had no way to get to any of them.
She hadn’t said a word, because she was afraid they would be mad at her and wouldn’t take care of her.
She thought she would be judged.
Little by little, the rest of the file started to make sense.
Grace didn’t answer calls because she was on a prepaid phone, and she was afraid of running out of minutes.
The all caps were just how she texted. She was 16. No one had ever told her it reads like yelling.
She didn’t go to physical therapy because she didn’t know it was part of healing, or that workers’ comp would pay for it.
She didn’t change her dressing because she had nothing to change it with. When she did, it hurt so much she was sure she was doing more harm than good. She didn’t know the signs of infection to watch for.
And underneath all of it was the weight she was carrying. Grace was the primary provider for her family: her mother and her two younger siblings. Her mother didn’t speak English. Grace had left school to work. While everyone waited for her to follow directions, she was trying to figure out how to buy food and pay the rent.
Meanwhile, each missed appointment went into her record as non-compliance. And her wound was in danger of becoming infected. Left the way it was, an infection could have cost her the very finger she was asking me about.
I couldn’t wait to get in the car.
I called the adjuster and told her everything. The missed appointments. Who Grace thought was paying. The prepaid phone. The all caps.
The adjuster was so empathetic.
“Let’s make sure she gets everything she needs,” she said. “Make sure you explain to her that we are taking care of her workers’ comp costs. Stay on the file to ensure everything goes smoothly.”
So I did. I told Grace and her mother that her workers’ comp costs were being taken care of, and that nothing would come out of her pocket. I made sure she knew how to care for her wound, what signs of infection to watch for, and why therapy mattered. I offered transportation so she could get to every appointment.
Grace started showing up. She changed her dressing as ordered. She went to therapy, learned her exercises, and did them every day.
Her mother came to every appointment. She was so thankful for her daughter.
Within two months, Grace told her doctor herself.
“I don’t want to come back. I need to get back to work. My finger is healed, and I do my exercises every day.”
The doctor was surprised. “Are you sure? We can see you one more time.”
“No,” Grace said. “You have done more than enough. I am finally healed.”
Her doctor discharged her from care and released her to full duty.
So I’ll leave you with this: Which file on your desk right now has a Grace in it?
To bring SAUBOU Consulting’s nurse case managers onto your workers’ compensation cases, contact us through our website or connect with me on LinkedIn.
Kimyette Saunders-Bouie, RN, CCM, is the founder of SAUBOU Consulting.
