Underlying rumblings in the workers’ compensation industry have for years lamented a perceived reduction in both the training of and investment in claims handling professionals. To my knowledge, this feeling, or observation by many has been anecdotal and osmotic by nature, gleaned from casual and professional observations over the years. As far as I know, there had not been a specific study closely examining the phenomenon.

Until now.

A study released a few weeks ago, the 2013 Workers' Compensation Benchmarking Study, produced by Rising Medical and primarily authored by Denise Zoe Gillen-Algire of Risk Navigation Group, casts an interesting if not somewhat scathing light on training and development perceptions within the claims management field in workers’ comp. It shows that, for a significant number in our industry, training is inadequate or non-existent for this critical position.

The study took a comprehensive look at claims management core competencies, medical performance management, talent retention and development as well as the impact of technology and data on our industry, and included a significant cross section of both company type and professional occupations. The result is a 107 page report detailing observations and comparisons of what companies believe they do in regards to these categories, and what they actually do.

For me, the results disclosed regarding training and development signal a huge issue for the industry.

For example, when asked the question, “Does your organization have a formal training program for new hire claims staff with little or no experience?”, 42% of respondents answered yes, while 37% answered no. However, if you factor out the 19% of respondents who indicated this question was not applicable to them, and only look at those to whom it applied, the number of respondents who answered “no” jumps to 47%.

Considering claims is where the money is spent and represents the front line of customer service at the most critical point in a vendor/customer relationship, it is shocking.

It is not much better for senior level claims people. In response to the question, “Does your organization provide technical training for senior-level claims adjustors?” the initial response was 49% positive, 30% negative. Again, excluding the results of those who indicated this did not apply to their company, that negative response jumps to 38%.

This result appears even slightly more absurd when you consider the emphasis on development included in the same respondents corporate strategic goals. Fully 85% of them indicated that staff development was included in their organizational/departmental strategic goals, yet only 54% indicated that their organization had a dedicated training and development group.

Ladies and gentleman, talk is cheap. It is also very expensive.

We all know there is a huge difference between “walking the walk” and “talking the talk”. Saying it is important and actually making it important are vastly different things. The disparity here is quite evident, and likely will not shock many “deep in the trenches” who live this dichotomy every day.

There are many surprising and at times amusing results from the other sections of this study. The misperceptions of technology implementation and integration might make you smile, until you realize the full potential ramifications (some respondents thought “copy and paste” qualified as systems integration). The fact that 66% of respondents say their organization does not use any medical provider outcomes or performance measuring protocols tells us we have a long way to go to in improving care while containing runaway medical outlays.

This study was well conceived and extremely informative, as it provides a comprehensive snapshot of an industry struggling with several key areas at a time of tremendously disruptive trends, and gives us a clear guidepost to what we need to do to better operate as an industry. It is worth a few minutes of your time for perusal. You can get more information from Rising Medical here, or you may download the full survey report in the “attachments” box to the right of this article.

In the net result, the training shortfalls indicated likely surprise no one, but should not be considered an acceptable trend. Claims handling in this country is getting more complicated, not less. Medical management is getting more complex, not simpler to navigate. It just lacks all reason and common sense that so many would be placed into this minefield, on the front lines of battle, and given no weapons or tools with which to survive. It is a costly and short sighted mistake from our industry. It costs us dearly in extended and unnecessary care, and hurts the people we are supposed to serve. No one wins in this war. Everyone loses.

Trust me, if we continue in failing to train, we will definitively be feeling the pain.

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