A Work Comp Claims Department and Chernobyl – One Major Similarity

Work Comp Claims Department and Chernobyl –  Manuals Will Not Fix  The Problem

How does a Work Comp Claims Department and Chernobyl end up in the same passage?  

The article title originates from an extremely highly lauded book – Midnight in Chernobyl.   The author’s breadth and depth of what occurred will astound any reader.   I cannot recommend the book enough if you want to know what really happened at the greatest nuclear disaster on earth.

How does the affable claims department  receive such a comparison?   One of the passages in the book jumped off the page.   

From page 68  of the book-

the atomic chieftains of NIKIET and the Kurchatov Institute apparently believed that a well-written set of manuals  would be enough to guarantee nuclear safety. The designers assumed that, so long as they followed the new instructions closely, human beings would act as promptly and unfailingly as any of the plant’s electromechanical safety systems.

But the staff of Soviet nuclear power plants, faced with ever-increasing production targets and constantly malfunctioning or inadequate equipment, and answerable to a bewildering and dysfunctional bureaucracy, had long become accustomed to bending or ignoring the rules in order to get their work done. And the updated instructions they received from NIKIET were neither explicit nor explained.

One of the new directives stipulated that a minimum number of control rods should henceforth be maintained within the core at all times—but NIKIET did not emphasize that this limit on the operational reactivity margin, or ORM, was a crucial safety precaution intended to prevent a major accident. Deprived of information about why such rules might be important, the operators went on with their work as usual, ignorant of the potentially catastrophic consequences of breaching them.

Any department in any company may possibly function like the NIKIET.   However, the manuals that I read the most over my career were claims manuals.   I designed, evaluated, and corrected many claims manuals over the years.   I recommend reading the passage very carefully as this appeared just before the accident

Performing claims audit – with the viewpoint of former adjusters, supervisors, managers, and VP;s – remains one of our most requested services.  The first document  any reviewer, auditor, or claims analyst asks for is the manual.   Why?

The claims manual supposedly directs the work comp claims department how to process and adjust claims in that certain company.   The manuals can be expansive or a few pages.    Whenever any self-insured employer asks about how their claims are handled, I suggest asking for a copy of the Third Party Administrator’s (TPA) claims manual.   Some TPA’s work comp claims departments are not that forthcoming with divulging their operations manual.   

Some TPA’s admitted they had no claims manual.  A few even asked me to write one for them.  Nowadays, that request seldom occurs due to the ability to compose a claims manual using online assistance.  If a work comp claims department does not cover a certain subject, one needs to refer to the industry standard.

I try not to be so critical of claims departments as some of my fellow blog article producers.   After riding the adjuster seat for many years, the critic task seems easy to do in most cases.  

The last bolded passage causes much chagrin in work comp claims department.   Teaching the work comp claims department why their operating manual is so important may be an on overlooked task that may cause a claims disaster. 

One of my largest concerns that relates to claims manuals arises when I periodically review a certain set of claims.   For instance, I reviewed the claims processes three years ago (i.e. June 20, 2016).  I look at the electronic manual’s computer file data that says something like: 

• File created February 1, 2010
• File last updated  June 20, 2016

You can find that info on any computer file.   This file notation meant that last time any update to the claims manual occurred three years ago when I updated it during a claims review or the carrier/TPA had hired me to update the manual. 

My recommendation remains that each section of a claims manual should be taught for at least an hour per month by the senior adjusting, supervisory and managerial staff of the work comp claims department.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.

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