WORKERS' COMP THOUGHT LEADERSHIP SERIES
Presented by Plethy Recupe
Simple Ideas for a Complex System
Unappreciated, Underused, Underpaid
by Bill Zachry, SCIF Board Member
Roger was the most knowledgeable worker’s compensation claims person I ever met. He knew the labor code; he knew all the case law and how each legal opinion applied to that claim which was in his hand. He knew how to accurately and consistently reserve claims (he was exceptional with this), he knew how to audit claims, and he knew how to resolve claims.
Roger was not very tactful. He was honest and opinionated. That lack of tact had a price. He told the CEO of the company that support of a particular law was a big mistake (he was right the law cost employers and insurance companies millions of dollars). As a result, he was banished to the Siberian claim office for a few years.
His customer service was exemplary if the customer was not trying to take advantage of him or of the company. If he felt that the employer or claimant was taking advantage of him, he became amazingly difficult to work with.
He was a bit rough around the edges, with no tolerance for mediocre claims handling and little patience for novice examiners. He had an opinion and was always willing to let you know what his opinion was and whether your opinion should be, on a particular claim or on any aspect of the law. He always told you exactly what needed to be done on the file and how to do it. He was rarely wrong.
He had been a supervisor at one point in his career, but he was not good at managing other people. He could barely manage his disdain for his own foibles and weaknesses, much less weaknesses in others.
His cleverness also gave him a razor-sharp wit which was sometimes difficult for folks to understand or appreciate.
Most examiners look at a career and expect to have five to ten years as an examiner, five to ten years as a supervisor, and then five to ten years as a clam’s manager. Eventually resulting in a Home-Office position, and, then becoming a VP.
Few expect to have a full career as a technical claim examiner. This is because few organizations have developed and implemented a “technical” track for examiners to follow in their careers.
Our industry would be better if we had a technical track for examiners to follow.
Most of the time, Roger is unappreciated, underused, and underpaid for the results that he produces on the claims.
However, because most Rogers are the highest-paid examiners in the office, there is sometimes a tendency to put that name on the list when there are layoffs. This position is particularly vulnerable in TPAs where many of the clients are not paying for superior claims results but are paying the lowest possible claims administration fees with no expectation of results.
How and where do you fit the “Rogers” into a claim’s office? How do you provide a career to Roger when he clearly is not a good supervisor? How do you pay Roger what he is worth? More importantly, how do you organize a claims operation to take advantage of the Rogers within the organization?
To maximize the claims results, claims administrators must learn how to take advantage of “Rogers” skills and experience. Embrace what he brings to the organization and use it.
Here are suggestions for maximizing the impact of Roger:
- Create a technical track for the claim’s operations (there are folks who are great examiners but not great supervisors).
- Be willing to pay more for senior technical track examiners than for
- Utilize the high-level technicians as technical mentors for new
- Assign the oldest and most difficult cases in the office to Roger with an expectation of closure with salvage within two months (I bet they succeed).
- Create a productivity index for all examiners and supervisors to help measure This will help determine the true value of the senior technical examiners.
- Have Roger help create and implement claims handling specialties such as:
- Toxic claims handling protocol Obesity claims handling protocol
- Back handling protocol
- Complex pain case handling protocol
- SIU / Fraud identification and handling protocol
- Assign Roger to the Special Investigations Unit to help detect and report worker’s compensation fraud.
- Put Roger in charge of settling the most complex cases in the office and give him credit for the results.
- As new laws, rules, and regulations are passed, Roger can help create new claims processes to fully implement the changes with a minimum of negative impact.
- Do not put Roger in front of those who do not understand his value or understand how his mind (If you do, both parties will end up frustrated).
- Do not put Roger in a supervisory position when he clearly is not supervisory material.
- Always be clear on the career path offered and expectations of
- Provide recognition for a job well
- If appropriate and possible, allow Roger to participate in industry forums as a presenter or as an expert who can bring front-line experience to theoretical processes.
- Fully explain the benefits of having superior claims skills and experience in the operations up the line to the VP of Claims and the
- The TPA should explain to the employer or insurance company that they have Roger working on the most difficult claims and that it is worth the extra fees to have him on the account.
It is important to recognize the diversity and results that a “Roger” brings to the organization. It is the responsibility of the management of the organization to use the brains and skills of these people to obtain extraordinary results, and to provide Roger with an appropriate career path that maximizes his skills and potential.