You have all been there: you have to make the dreaded call to NHADA-WCT to report an injury or get assistance with difficult questions. We always make the joke, “No one ever calls just to say hi.” The truth is we love the calls; we would rather hear from you early and help you through the process than later when the issues are more difficult to resolve.
NHADA-WCT brings a unique team approach to the management of workers’ compensation claims. Our six team members have been here for between three and 37 years! Collectively that is a HUGE amount of experience! Each team member has a specific role and focus in the management of claims and needs to obtain and share information gathered from the injured worker, the employer, and the treating provider, just to name a few. As a result, there may be what seems like a barrage of questions coming from our office, and some may be quite similar. The process can sometimes appear quite daunting between forms to fill out, interview questions, payroll issues, time lost from work, and coming up with temporary alternative duties. The list seems to go on and on; we are here to help you through this process and save money, which can seem quite overwhelming at times.
A brief reintroduction to each team member will help you understand their role in our claims management process and, again, why so many questions?
Pete Sheffer — Director of Workers Compensation
Pete is responsible for the day-to-day operation of the claims department and oversees the staff. As well as his management duties, he is responsible for the appropriate reserving of claims, reviewing all open claims every 30-60-90 days, and he maintains an active caseload of lost time and medical-only claims. Once a week, he runs a claims review meeting with the team to review all lost time claims, strategize return to work, obtain medical status updates, and allow the team to come together and keep everyone up to date. Even though the road adjuster does the recorded statements with the injured workers, Pete will also have his own set of questions for the employee and the employer. Pete also likes to answer questions as much as he likes to ask them; he is an expert at our drug screening policy, the NH Workers Compensation Statute, and can assist with your claims concerns. Pete’s email is psheffer@nhada.com.
Marta Silakka — Nurse Case Manager
Marta is a registered nurse, certified case manager and certified occupational health nurse specialist. She is responsible for the management of the medical portion of the injured workers’ claims. Most claims start with a call to Marta, and actually, that is what we prefer. Injured workers and their employer call Marta at the time of the injury; she then reviews the extent of the injury by asking a variety of medical questions and assists with the most appropriate in-network referral for medical care. She is able to assist the injured worker with same-day specialty care, whether it is to an eye doctor, an orthopedic, or an occupational medicine provider. Marta will continue to follow the claims through maximal medical improvement. She will also share pertinent medical information with our members and the claims team to expedite their return to work and their pre-injury status. When injured workers are out of work, she will contact them weekly to check-in and see how they are doing. Her email is msilakka@nhada.com.
Justin Dowdy — Claims Representative and Road Adjuster
Justin establishes “face to face” contact with the injured worker, the employer, witnesses and works with all parties during the investigation process. He is in charge of getting the “who/what/where/when” details of the injury. Justin’s initial interviews are a crucial piece of the claims management process. The purpose of his investigation is to determine whether the injury as reported by the injured worker meets the definition of an “injury” per the NH Workers Compensation Statute. An injury is defined as “an accidental injury arising out of and in the course of the employment.” Justin’s questions to the injured worker and the employer are to help determine whether the injury happened while the employee was at work and whether the injury was caused by a risk or hazard created by the employment. Not every injury that happens at work is caused by work. Justin’s responsibility is to collect information during the investigation to help the adjuster assigned to the case determine which claims will be covered and which will not. As well as being the Road Adjuster, Justin carries an active caseload of both lost time and medical-only claims. Justin will ask many questions, and he may ask the member about video footage and witnesses as part of the complete investigation. He is a crucial part of the weekly claims meetings giving the team an overview of his meetings with the injured worker. Justin’s email is jdowdy@nhada.com.
Deborah Handrahan — Member Services Coordinator
Deb’s position focuses on educating and assisting members with all aspects of the claims process, from how to report an injury to assisting with temporary alternative duty. She can assist members with identifying and creating temporary alternative duty positions for the injured worker to get them back to work sooner. Deb communicates with the employer and medical provider on job descriptions and the availability of light-duty. She will work closely with all parties involved to ensure the return to work is safely within the outlined restrictions. Her role is crucial in expediting return to work; she works closely with the team in the weekly meetings brainstorming options for light duty. In addition, she travels with the Loss Prevention Teams and attends members’ safety committee meetings to review the workers’ compensation process and managed care. She also provides training for the HR staff and managers. Deb collects and notarizes documents from our members for the purpose of The Second Injury Fund, which gives back money to the trust yearly. She may reach out and request a review of certain files to assist in this process. Deb’s email is dhandrahan@nhada.com.
Marianne Gourgiotis — Underwriter
Marianne is responsible for giving quotes to new members, overseeing premium and billing, and she is highly involved in audits, rebates and the calculation of experience modification factors. She is a wealth of information to our members who have questions regarding payroll audits, changes in your operation and secondary locations and their effects on your premium. She is responsible for sharing information with the Department of Labor, the actuary, the reinsurance carrier, and provides members with OSHA-required reports. Marianne is also a licensed adjuster and oversees a caseload of medical-only claims. We are proud to say she is the NHADA employee with the most longevity, going into her 37th year at NHADA this year! She has had many different roles at NHADA over the years, with the most in Workers’ Compensation. Having been here the longest, she likely will know the answer to most questions. Her email is mgourgiotis@nhada.com.
Anne Marie Fallon — Administrative Assistant
Anne Marie is responsible for the administrative functions of the claims and loss prevention departments. You may not hear from her directly, but her role is crucial to the workers’ compensation process as she sends out all the required correspondence to our members, the injured workers, and medical providers. She also handles requests for information and medical releases, wage schedules, questionnaires, requests for police reports, as well as managing the incoming and outgoing correspondence from the department. Anne Marie shares her time with Loss Prevention and assists that team with all their administrative needs. Anne Marie’s email is afallon@nhada.com.
Within 48 hours of injury, a member may speak to Marta about the details of the injury, they may speak to Pete and Justin about the details of the injury, and this may include inquiries regarding witnesses, video surveillance, employment history and many other details, and a member may hear from Deb regarding light-duty and getting an employee back to work. Our goal is not to drive you crazy with our questions but rather to keep members’ premiums low and rebates high by expertly managing your claims. As you can see, our team is expert in workers’ compensation, and we are here to help you through the process. Please reach out to us anytime.
