Workers' compensation and disability managers at the 16th Annual Workers' Compensation and Disability ConferenceŽ& Expo hoping to mend the schism between people and technology in the resolution of workers' comp claims came away empty-handed.
The rift between those in the industry who believe treating people as employees first and foremost--in other words, the billers or claimants--and those who believe technology holds the key to improving the processing of workers' comp claims--in other words the payers or carriers and the vendors who serve them--is alive and well.
Experts from the billing side of the equation--managers like Yolanda Romero, workers' comp director for the Southeastern Pennsylvania Transportation Authority; James Pocius, a Scranton, Pa.-based workers' comp attorney; and Dr. David Cooper, director of orthopedic surgery at the Knee Center in Wilkes-Barre, Pa.--underscored the importance of respecting claimants and treating employees as living, breathing human beings.
"The bottom line is respect, respect, respect," said Romero about working with unions. Romero's been credited with making so much headway with organized labor over the past seven years that its leaders are now calling her when they suspect employees are filing fraudulent compensation claims.
Companies and organizations that honor their workers and provide meaningful channels for them to express their worries and complaints are those that are going to have the best success in reducing workers' comp claims and costs, she said.
And who could argue with that? The audience, made up primarily of workers' comp and disability managers, was squarely on Romero's side, judging by the applause every time panelists mentioned the critical importance of treating employees as people.
But on the other side of the workers' comp claims equation, voices of executives representing the insurance carriers--in other words, those on whom it falls to actually pay the claims--proved to be equally persuasive. Industry veterans, like Richard Marko, a senior vice president in the Boston office of Liberty Mutual, the nation's largest workers' comp carrier; Glen Pitruzzello, a vice president in the workers' comp practice of The Hartford in Hartford, Conn.; and Maddy Bowling, a long-time workers' comp consultant, stood firm in their conviction that claims-payers were almost duty-bound to use the technological resources at their disposal to alter the outcome of a claim.
Respecting injured workers is all very well, but never, ever talk about claims without analyzing the data, they said. The more you look at data, the more you can change the process. The more you change the process, the more you influence costs and the outcome of the claim.
"Process is important," said Marko. "It's important in two ways. It drives outcomes, so that's important. It also determines costs."
There's no doubt that for the workers' comp claims-payers, process determines outcome, and combing through data is the key to managing long-tail claims that at a glance look routine, yet over time hemorrhage tens of millions of dollars.
Marko said the in-depth study of medical records to control costs has been integral in Liberty Mutual's ability to progress against claims fraud, in which cases are treated and billed at levels far above medical necessity.
"Use your data to actively analyze what impact your current cost-control program is having on your overall results," added Bowling.
And thus it went in keynote presentations at McCormick Place in Chicago, as the workers' comp billers squared off against the payers--all against the backdrop of softening rates and the stellar 2006 financial results posted by insurance carriers. Is there room for the industry to strike a middle ground, an acceptable compromise? Companies that find a "middle way" will come out on top, according to one expert.
"There has got to be a middle ground between technology and people," said Mark Noonan, a workers' comp practice leader with Marsh USA's Boston office.Treading this rarified middle ground between the traditional approaches of respect for human beings in need of warmth and attention, and the advances brought on by the latest techniques is going to determine the winner, according to Noonan.
"Whoever gets that right is going to do well in this business," he said.
Additional reporting was conducted by Senior Editor Dan Reynolds.
January 1, 2008
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