By Nancy Grover
Diana J. Rich.
A 30-year veteran of risk and insurance management, Rich is now focused on the public sector in her role as the workers' compensation program manager for the California Joint Powers Insurance Authority. The organization provides risk management solutions for public agency members.
Prior to her employment with the JPIA, she gained extensive experience as a claims adjuster and supervisor, account executive for a large regional insurance brokerage, and manager of legal assistants for a workers' comp defense firm. Her risk management background includes working with employers in the publishing, hospitality, and temporary staffing industries. Certified by the State of California as a self-insurance administrator, Rich serves on the board of directors for the Council of Self-Insured Public Agencies.
As someone who has been involved in the workers' comp system for many years, she also has witnessed the evolution of the industry brought about by legislative and cultural changes. A major consequence of the high level of regulation, she says, is that adjusters no longer have the time or ability to exercise critical thinking.
"The adjusters are very highly paid for their analytic skills, but they don't get to exercise them," she said. "Our California system has so many deadlines and forms they end up really just pushing buttons. They don't step back and look at how they should respond to developments to really manage and defend a claim."
For example, Rich says the utilization review process misfires if adjusters don't look to make sure medical reporting is complete, resulting in unnecessary delays and denials of treatment and increasing the frustration for injured workers and employers.
Another area that she believes needs attention involves communication by the adjusters.
"I am really seeing a lack of communication by the adjuster with the injured worker and employer," she said. "Adjusters should not be afraid of calling or emailing to stay in touch. I'd like to see the claims adjuster calling and saying, 'Look, we have to follow the law. Here is the reason your treatment was denied, and here's how you can help fix it.'"
The use of technology in workers' comp may be impeding the process, she said. "Especially because of paperless files, there is greater temptation to top sheet," Rich said. "Adjustors do not capture key information on a claim and put it in a spot where they can refer to it later. When looking at a claim on screen, they only scroll down two or three screens and forget there is a key detail that happened six months ago. . . . The next person who picks up the claim has no idea what has been going on."
Rich believes the system should rethink how it incentivizes its claims handlers and focus less on processes and more on outcomes. She makes an analogy to a meat-packing operation.
"The idea is you will move files along and achieve acceptable results. The problem is, like in the meat-packing line, the meat is cut beautifully, the label is on perfectly, but it's rotten meat that is being processed," she said. "If you measure only on compliance, your claims handling can be perfect on a rotten claim that should have been denied."
Solutions rest largely with risk managers and organizations, and she challenges them to value quality over price. "If you want trained claims adjusters and effective supervision, do not pay bottom dollar," she said. "You may think you are saving $100,000 on your claims administration contract, but that's only the cost of one litigated claim, or one botched back surgery, or an accepted claim that should have been investigated and denied."
Katrina A. Zitnik.
As the director of workers' compensation for Costco Wholesale, Zitnik is responsible for managing the programs that provide benefits to injured employees for the company's entire U.S. operations. Among her current concerns is finding ways to reduce unnecessary costs in the system.
Zitnik has more than 25 years in the insurance industry. Her previous positions include branch manager with Crawford & Company, senior consultant with Marsh, and safety and claims manager for King County in Washington.
Pain management in the workers' comp system is a particular concern of hers, especially in light of recent actions in her home state to curb the use of opioids. "Washington state hasbeen a leader in identifying the problem and in proposing reasonable solutions," she said."The Seattle Times recently published stories that were critical of the use of methadone in the state's workers' comp and Medicaid systems as a less expensive alternative to other opioids. This is an issue that is important to all health care systems and has no easy answers."
In addition to serving on the advisory board of the National Workers' Compensation and Disability ConferenceŽ & Expo, Zitnik also serves on the boards of the Workers Compensation Research Institute and the National Council of Self Insurers. Additionally, she is the president of the Washington Self-Insured Association. She is a graduate of Stephens College.
Read more at the WorkersComp Forum homepage.
February 6, 2012
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