Friday, February 5, 2016

Keep It Simple

Boscoe is simple...
Workers' compensation is designed to benefit two opposite interests: the people that get hurt doing work and the people that pay for that work to get done.

While these two interests may seem inapposite, the reality is that both have very similar characteristics, namely both groups are highly diversified in terms of sophistication and education, and both groups have deep historical issues with mistrust of the other.

In the middle are the financial services that make the system of workers' compensation possible by providing the method for accumulating and distributing money.

Our stereotype of the employer is of sophistication, and of the worker naiveté. Of course, both applications are erroneous. The fact is that the vast majority of employers aren't sophisticated when it comes to workers' compensation, and many workers have education and knowledge, albeit when it comes to work comp there's a void.

Consequently the third spoke in the workers' compensation wheel of vested interests, government, requires communications to both employers and workers to be at a level where there isn't much dispute or question about what's being said.

Employer contracts, also generically known as insurance policies, must go through an administrative review process and approved by a state agency, typically a department of insurance, before they can be sold out on the insurance marketplace.

And notices or forms to workers about their claims likewise must meet certain understandability standards.

Two WorkCompCentral stories this morning highlight this dichotomy and the government's role as a communications arbiter.

In one, an employer represented by attorney Nicholas Roxborough, is asking the California Department of Insurance to make precedent an administrative law judge ruling, adopted by the CDI, invalidating a policy side agreement that would force policy holder Shasta Linen to arbitrate disputes with EquityComp administrator Applied Underwriters in the British Virgin Islands using Nebraska law. 

The ALJ ruling, adopted by the CDI, voided that provision because it wasn't filed with the Workers' Compensation Insurance Rating Bureau or the CDI as required by law. (Applied Underwriters, for the record, disputes this finding and says it is seeking appeal).

And in Texas that state's Division of Workers' Compensation apparently has seen too many forms and notices to injured workers that were either vague, or used incomprehensible technical terms (at least relative to workers), causing it to send a memo reminding insurance carriers and other interested parties about the importance of communicating clearly.

DWC says this type of communication to the insurance industry is routine - a reminder that they need to keep things simple for the consuming public.

The EquityComp plan was the subject of a patent application, which describes the mind-numbingly complex nature of the contract.

"Disclosed herein is a reinsurance-based approach to providing non-linear retrospective premium plans to insureds that may not have the option of such a plan directly," the patent application says. "It also has the surprising ability to enable non-linear plans while at the same time complying with state regulations."

I have no idea what any of that means. I can only imagine how complex the actual language of the policy reads.

The Texas DWC says examples of statements that don’t meet the requirement to clearly explain the basis of the denial or dispute to an injured worker include “under investigation,” “eligibility questioned” and “no medical evidence to support disability.” What they want communicated are the factual basis for denial or delay.

One of the hallmarks of education is an expansion of linguistic abilities - using strings of multisyllabic words in an effort to be precise. But often that is perceived as an obfuscation and magic cards trick to get away with something that otherwise would be objectionable if the reader knew what was actually being said.

Which is why the government has rules in place to keep a check on those with a skill in communication complexity and uses its enforcement power to reel in errant behavior.

Me? I just keep things simple. 

My wife chastised me the other day for my prolific use of a certain four letter word that is associated with carnal knowledge.

"The reason I use that word so much," I replied, "is because it's the only monosyllabic word I know."

Keep it simple and stay out of trouble...

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