Back in 1946 a group of 22 American charities banded together to form something called the Cooperative for American Remittances to Europe and the original CARE package was invented. CARE represented a revolutionary idea: the people of war-ravaged Europe were not abstractions or millions of faceless refugees. They were people just like us who needed help getting their lives back. December seems like an appropriate time to take a look at our evolving understanding of the importance of plain, old-fashioned care in handling claims and, yes, helping people get their lives back.
Google “insurance claims handling” and you will see a lot of technical articles about regulations and best practices. A claim is a legal process with lots of boxes to be checked and forms to be filled out and filed. But what if the claim is a workers’ compensation event or a personal injury suffered in a traffic accident or in a wet foyer of an office building? We are pleased to note that in recent years, leading claims organizations have begun to think about these injured people as, well, people, in much the same way that the CARE movement looked past politics and understood the needs of refugees as people in distress.
Claims departments exist because bad things happen to innocent people, from accidents on the job to putting a foot wrong on a polished floor. The mission of the claim adjuster in such cases is not just to gather and process information and push the right key to produce the right check for the right amount under the policy—and not a penny more. We have a duty of care to help the injured party get their life back together, to regain function, and to get back into family life and society.
The best way to understand this is to have a serious, life-altering claim yourself and see the claim process from the view of the claimant who might or might not get their life back. The clinical details are not important here, but your correspondent had such a claim resulting from an airline accident while on company business. It was clear from the git-go that my comp claim was just another set of blank boxes for just another paint-by-numbers process. The adjuster had me written off as a total-permanent from call one and wanted to set in motion the filings for my LTD benefit to dump part of the liability from the comp plan in a low-ball settlement.*
My only case manager was my wife. Between us, we found a specialist willing to try an experimental surgery, hammered the adjuster into agreeing to pay for it (as required by state law), and put together my RTW plan and the eventual partial-permanent settlement. I could do that because I knew comp law cold. Since that event, I have been laser focused on how to make the claims process work for those injured persons who are not claim professionals themselves.
It all starts with taking pains to understand who the claimant is, their family situation, motivations, employment situation, likely future—the whole, three-dimensional human being. This means talking with the claimant, not to or at the claimant. In my current work, I am involved in developing decision-support systems for claims. The purpose of such systems is not to eliminate adjusters; it is to have machines do the necessary busy work to give the adjuster time to communicate effectively with the claimant as well as the provider, the employer, or other folks involved in the process. Humans talking to humans is where care happens.**
Caring is also a very practical virtue. We know that where adjusters make informed, proactive connections, RTW happens sooner, fewer attorneys get involved, and claims close favorably. Have you talked with your claims organization about the importance of stopping to ask and then listen, of not thinking about the claimant as the “party of the first part”? Do you and your adjusters understand that you are working with people who are in distress, often financial as well as physical? When a claim involves a family breadwinner, it is not just about the individual. No less than doctors or nurses or therapists, claims adjusters are in a caring profession.
It is ridiculously easy to think of claims adjusting as a type of video game. Us against them. But like those faceless refugees in 1946, these digital entries are real people. What is the role of care in your claims program? Just another four-letter word?
*All this was almost 40 years ago but don’t assume that it can’t happen here and now. Stay close to your claims people and make certain they know how you want your claimants cared for.
**In his novel, Howard’s End, EM Forster tells us, “Only connect!” The alternative is to live your life in fragments.