Simple Concepts for a Complex System: I hate that Claimant

31 Mar, 2022 Bill Zachry

                               

Most of the time, when you first meet someone, a relationship takes time to develop. Sometimes you immediately like or hate a person. I do not exactly know what magic chemistry makes someone immediately like or hate another when they first meet.

Most true relationships take time to develop. Usually quality time spent together, and common experiences make the relationship last.

It is quite difficult to create a great relationship over the phone. Yet this is the goal of good examiners. Good examiners want to know the injured workers well enough to truly help during a time of need. They will bend over backwards to help the injured workers. They want to help maximize recovery and return to work.

If the examiner genuinely likes the injured worker, the results can be miraculous.

When the examiner has worked diligently to help the injured worker, he/she may feel betrayed when the injured worker gets an attorney and litigates the claim.

This betrayal can seem worse if the applicant’s attorney is problematic, unnecessarily adversarial, and unreasonably demanding.

This betrayal can result in the examiner harboring anger or hatred at the injured worker. Occasionally the examiner may have hated the injured worker from day one. I could not always understand why.

If for any reason, the examiner does not like the injured worker, (or the applicant’s attorney) the experience can be toxic.

One great indication of this problem is when subrosa is unreasonably requested.

Understanding the potential negative impact of a toxic claims handling environment in a claims office is important. Doing something about it is even more important.

I did not normally transfer files within an office because of the potential cost impact on the files. However, this scenario was the exception.

As a supervisor, once a year I would ask the examiners to identify the four or five claimants that they hated. I would then reassign those claims to my caseload and would give the examiner replacements which fit their personality.

I always found that without the toxic environment muddling the results, that all the claims which had been reassigned were closed (lower than reserved) within four months of reassignments.

This process resulted in happier and more productive examiners. And was always in the best interest of the injured workers.


  • AI california case management case management focus claims cms compensability compliance conferences courts covid do you know the rule exclusive remedy florida FMLA glossary check health care Healthcare iowa leadership medical medicare minnesota NCCI new jersey new york ohio osha pennsylvania Safety state info technology tennessee texas violence virginia WDYT west virginia what do you think women's history month workers' comp 101 workers' recovery workers' compensation contact information Workplace Safety Workplace Violence


  • Read Also

    About The Author

    • Bill Zachry

      William M "Bill" Zachry is a Board member of the California State Compensation Insurance Fund, Appointed by Governors Arnold Schwarzenegger and Jerry Brown. He served 3 years as a Senior Fellow at the Sedgwick Institute. His term ended in January 2020. Zachry was awarded the Summa CompLaude award in November of 2020, the RIMS Risk Manager of the Year 2014, the CCWC Workers Compensation Professional of the Year 2016, Co-Chair AMICUS Committee California Chamber of Commerce. He is the former GVP Risk management Safeway /Albertson's Former Board Member California Self Insurers' Security Fund, former Co-Chair California Chamber of Commerce AMICUS committee Chair California Fraud Assessment Commission Zenith Insurance Company VP Claims HIH (C.E.Heath) (Care America) S.V.P. Claims. References

    Read More

    Request a Demo

    To request a free demo of one of our products, please fill in this form. Our sales team will get back to you shortly.