Tried and true practices improve insured's experience, keep costs down

The latest and greatest cost-cutting measures may not be as effective as more traditional methods. In fact, some of the advice we got as children may translate well to the workers' comp system in these cost-conscious days.

"Know your limits" and "be nice to others" can work wonders toward getting better outcomes, according to an industry veteran. He advocates maintaining workable caseloads and creating non-adversarial relationships with injured workers to protect the bottom line.

"It's common knowledge in the industry that the quality of outcomes deteriorates rapidly and dramatically the higher pending caseloads go above the 140 to 150 number," said Charles J. Manzo, senior vice president of claims for New York-based Majestic Insurance Co. "The quality falls off the table, the claim becomes costlier, and the life of the claim is extended."

NFL seeks to seal the deal against players filing in California (04/19/12)
Washington: DLI looks to establish medical provider network (09/10/12)
Physician-owned surgery centers come under researchers' scrutiny (06/18/12)
Coalition disputes contentions in think tank's report on N.Y. assessments (04/19/12)
Report outlines effective strategies for successful self-insurance groups (06/18/12)

Manzo says adjusters and examiners that handle between 125 and 140 cases at a time are more likely to see shorter claim lives and lower average claim costs. Doing that in this economy is possible by efficient utilization of existing resources based on experience level.

"There are always cases that are inactive -- no longer treating, waiting for a permanency award, or treatment has dwindled to symptomatic care. So you could classify those as inactive or marginally active," Manzo said. "They could be reassigned to less experienced adjusters; there's less to do on them."

The more experienced adjusters could then be free to spend more time on active claims and be able to manage them more effectively. Additionally, you could consider triaging claims.

"Following a statistical analysis of our claims, we found that 5 percent of claims accounted for 30 percent of costs," he said. Of those costly claims, he said nearly half involved claimants over the age of 50; more than half were neck and back injuries resulting from lifting and slips and falls.

"This gave us the wherewithal to triage the claim," Manzo said. "When a claim comes in that meets these criteria, you can almost assume it will develop into one of the most expensive 5 percent."

Manzo suggests identifying claims on a scale of one to three, from least to most costly. The level three claims are the 5 percent and should be sent to the most experienced adjusters.

Be nice. If your litigation rates are high, you might try working with rather than against the claimant.

"The us vs. them adversarial environment that some adjusters and examiners create does not really help in managing and mitigating the cost of that claim," he said. "It creates animosity and mistrust, encouraging the injured worker to seek the advice of counsel."

Instead, he recommends approaching the injured worker with honey instead of vinegar.

"As an examiner or adjuster, if you fully explain your role in that first call to the claimant and explain what their benefits are, you make them feel as though you are there to help them get the benefits they deserve and are entitled to under the law of the state," he said. "Follow up with them every couple of weeks -- not to badger, but in a friendly way. You want them to feel as though you're not out to get them."

Manzo said the insurance industry can do a better job in customer service -- not only to policyholders but to injured workers as well.

"We do have some control over the environment we create between the claimant and the carrier, and it all starts with the very first call we make to that injured worker," he said.

Read more at the WorkersComp Forum homepage.

November 29, 2010

Newsletter Sign-up