We spend a great deal of time talking about ways that the workers’ compensation system could be improved. Much of that conversation centers around how adjusters and claims professionals could do their job better; how they could change their methods to get better results. Rarely, if ever, in these conversations have we really discussed the daily challenges and frustrations that these professionals experience.
It is by no means an easy job. And many times, it is a thankless one.
Over the years I have made the acquaintance via Facebook of numerous claims professionals from the workers’ compensation industry. A good number of them are from one company that I have written about previously, who through one connection or another sent me a friend request at some point over the years. I’ve never met most of them, yet I feel as though I’ve come to know them through their posts and interactions on the social media platform.
Last week one of them made an interesting post. It played off the old saying from the classic movie It’s a Wonderful Life; “Every time a bell rings an angel gets its wings.”
His version was a bit darker, however. It can best be summarized with the saying, “Every time a medical provider lies, an innocent puppy dies.”
His actual post was:
“Every time a medical provider mails off a bill, then tells the patient we didn’t pay it when WE JUST NOW GOT IT IN THE MAIL… every time that happens, a puppy dies.”
That comment immediately seemed to strike a chord with fellow claim pro’s as multiple comments followed in very short order. The first was, “So much truth…..”
Then followed, “Every time a pharmacy says ‘they’re not paying for it’ without giving us a call about the error code … two puppies die.” That earned the reply of “yes. This one,” as well as the original author commenting, “If it was because they were trying to run it through the wrong system, the entire litter dies.”
Other commenters started weighing in, with the general tone taking a more morbid direction from that point out.
“Every time an MRI facility sits around doing nothing and expects the adjuster to use ESP to just randomly call a facility and approve an MRI that no one has called about an Orca dies. I run into this all the time. Somehow we are supposed to know what facility is doing the MRI and call them to ask if they need an approval?”
“every time a provider refuses to put a precert through the mco then tells everyone the adjuster needs to do it. A litter of kittens die.”
“the third time a provider calls for approval that you have given twice before a baby harp seal is made into a coat.”
“That totally happened yesterday! And then when I called back after they left a v/m, they were confused because I had already approved it! Seems they weren’t all on the same page at that office.”
And so it went. I popped in to mention that they all needed a vacation, a comment that received a rousing response with a variety of positive animated GIF’s. It also received the disturbing comment of, “I need a vacation so I can go club some baby seals. Been getting a lot of redundant calls and there is a backlog of coat orders!”
Fly that guy to Hawaii or the Bahamas. Now.
These comments show the true potential for frustration in the claims management sector. It is a difficult job. The claims professional of today must ply their craft with the cooperation and assistance of a multitude of different players. They must coordinate medical and pharmacy services, as well as rehabilitative care and a host of follow up services. The modern adjuster today is as much a professional juggler as they are a claims professional.
I’ve never worked in the claims field, but it strikes me that the job in many ways is much tougher than 30 years ago. People who managed claims “in the old days” had much more direct control over many facets of their job. They could make more decisions and directly write checks. Today, it seems to me that so many tasks have been outsourced that the modern adjuster is merely a conductor of the orchestra, and no longer plays any specific instrument.
And if your woodwinds or brass sections suck more than they blow, or your percussionists march to the beat of a different drummer, it can be one heck of a frustrating position to be in.
And we have not even ventured into the increasing caseloads seen on claims desks in the last decade or two. Or the stifling effects of continual legislative reform and increased oversight of regulatory agencies. Add it all up, and the claims job just keeps getting tougher, and it is easy to let the frustration show.
Companies that manage workers’ compensation claims need to look beyond basic training for their team of adjusters. They should strive to provide services and reliable support that allow these ‘directors’ to competently lead the band. While you can’t control every doctor or every pharmacist, you can hold your networks and vendors accountable, and demand they be responsive to your needs if they want to keep your business. If you want to know where to start, ask your adjusters on the front line. They can tell you who does and does not perform well. It would go a long way in improving your claims environment, not to mention save a ton of puppies and baby seals.