The "Just a Claims Guy" Fallacy

12 Aug, 2012 Bob Wilson


I think claims people in workers' comp do not get a fair shake from the industry. 

I have heard a few people over the years use the phrase “he's just a claims guy”, or “they are only in claims”, when talking about some person who happens to work in that area within the workers' compensation sector. The comment, made by those outside that job description, is usually not conveyed with a tremendous amount of respect. The clear indication is that claims people do not always have the total admiration of the rest of the industry they serve.

Not having a claims background, and indeed coming at the workers' comp industry from an employer perspective, this has always puzzled me. Then last week, a friend who is a claim's professional for a well known company and I were talking when he made the semi-disparaging joke, “Well, I am just a claims guy”. I took the opportunity to broach that subject, asking him why his area was at times viewed negatively by those in other departments. His answer confirmed my suspicions; that claims represent a necessary evil, an expense to the industry, and are not viewed as a revenue generating opportunity for the company.

What a horrendous mistake that is. In all reality quite the opposite is true.

In my experience, claims professionals are the front line in customer service, and will often make the single key difference in client retention year after year. These are the people who actually deal with your customers, who manage their recovering workers while protecting their interests. And it should not be taken lightly that they must do this at the low point of an insurer/employer relationship; when an employee is injured, there is a claim, and assets are at risk. The very nature of their position means they start from a negative advantage, and it is only their training, dedication and skill that can improve the situation going forward. To simply view that person as an “expense” not only sells them short, it undercuts the entire value of your operation.

After all, when the rubber hits the road, this is the business we are in. 

Good restaurateurs do not view their cooks and servers as simply an “expense”, as they know those job codes are absolutely critical for serving and pleasing their customers. The same can be said for a variety of businesses, who must utilize employees who do not necessarily engage in direct sales, but nonetheless are vital for completing the task of serving customers needs. Is a car mechanic not worthy of training or respect because they have no sales function at the repair shop? Hardly. Good mechanics are difficult to find. Good auto shop managers understand this simple concept.

It is quite possible that this negative view of claims actually harms your operation. When a department is subjugated and demeaned in value, that could translate into actions that deprive it of proper training, staffing and equipment to do the job as it should be done. That leads to a service deterioration that results in a self fulfilling prophecy; an ineffective and inefficient department that serves no one well and in fact ends up being simply what it was originally thought to be – an expense to the company.

As an alternative philosophy, I have been an advocate of elevating the claims position as a key element in changing our approach to recovery management, a move I believe is critical if the industry is to successfully adapt to disability and entitlement challenges we face. I have advocated that adjustors be trained more thoroughly, and be given more appropriate titles such as “Recovery Specialists”, or even better, “Recovery Counselors”. This is a key position that makes the difference between success and failure in your operation, and the dependency on it will only increase in the future.

Your business development and marketing people may be very effective at bringing that new customer through your door, but take my word; if your claims department is filled with nothing but untrained monkeys flinging pooh, it will be a short lived relationship. All the marketing glitz in the world won't be able to counter that.

So to those in the industry who are not associated with claims, give those folks the respect they deserve. Your paycheck largely depends on them.

And my advice to you, if you happen to be on the claim side of the business, is this: The next time someone tries to dismiss your value by saying that you “are just a claims guy”, stand straight, look them directly in the eye, and say;

 “You bet your ass, I am.”

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