Culture and Claims

Jon Pearson, Director of Life Path Services for QLI, a spine and brain injury rehabilitation service, gave a wonderful presentation about returning folks to a new normal during the recovery from injury at the Self Insurance Institute of America's Workers' Compensation Executive Forum yesterday.

Part of what he talked about was the team at QLI and how crucial they were to the success of the treatment model.

"If people don't want to work there," Pearson reflected, "then who would want to be a patient there?"

That observation goes well beyond QLI's business model.

Indeed - later in the day a`member on the panel for "Out Front Ideas: How successful Partnerships enhance Your Workers' Compensation Program" noted that claims adjusters have the toughest jobs in workers' compensation because they are expected to deal with their clients (injured workers) with empathy and compassion, yet meet conflicting production and financial goals.

The industry is currently fretting about the drain of talent on the front ends. Attracting, recruiting and retaining good claims handlers is at the top of every work comp adjusting house executive's lists.

How much does the internal culture of a claims house affect the quality of the claims handling? How many people are unwittingly thrown into a claims management situation where the handlers don't want to be there? How much of that contributes to a state's good, or bad, claims ratings and experience?

The Workers Compensation Research Institute recently released survey results of client satisfaction with workers' compensation medical care comparing results across 14 states. The middle of the country scored the highest by far, regardless of whether there were fee schedules, treatment guidelines, etc. Florida was miserably at the bottom.

How much client satisfaction was not the product of the actual medical care, but really of the claims handling experience? After all, the injured worker has to go through the claims handler first to get to the medical care provider...

Obviously self insured entities have much greater say in their claims handling. They competitively seek bids from claims houses, and one of the overall messages coming from the SIIA conference is, essentially, you get what you pay for in claims handling.

So while pricing the job is a consideration, the quality that is provided has a much bigger role; what Out Front panelist Stu Thompson, CEO of The Builders Group, referred simply to as, "value."

We all know of claims handlers who are besieged with extraordinarily high case loads. And there are others that have more reasonable loads.

Kevin Confetti, Deputy Chief Risk Officer for the University of California, said his claims staff's maximum is 100 files per adjuster. He claims very high satisfaction ratings from clients, and good claims experience numbers. I didn't ask him if his handlers like working there, but I have to assume that being a part of the California University payroll isn't that bad of a gig.

The reality of workers' compensation is that the claims process has the most impact: perceptions, finances, expenses and ultimately outcomes are all tied to how well any particular claim is managed.

My take from this week's seminar education is that the claims experience is intimately connected with the happiness of the claims staff. The quality of the service, i.e. the value, is ultimately the product of how well the claims handler deals with the client; from setting expectations up front, to communicating through out the process, to ensuring obstacles are smoothed.

A disgruntled, unhappy, under-appreciated, unmotivated claims staff isn't going to return value.

If the claims staff doesn't want to work there, then would I want my work injured to be clients there?

But, if your claims staff does like their work, and that is reflected in good outcomes, then tell the world about it with a Comp Laude nomination...