Bipartisan! If we hear that word once we hear it 500 times a day. Enough already! Let's just get something done.
Well, the claims process, from the chair of the customer (and the injured worker) , is often viewed much like our bipartisan politicians; a lot of explanation about what has gone on and how we got to this point but very little in the way of demonstrable solutions.
So it is with the Claims Process for many claims organizations. A lot of opinions on what should be done but little in the way of demonstrable progress. Things that will affect the bottom line. The fundamental challenge remains, as it has for some time, to respond to a loss and begin meaningful management as soon as possible.
Many tout a 24-hour contact rule. So what is "contact"? Does making a call and leaving a voice mail message constitute contact? When contact IS made is the discussion meaningful for the injured worker and the employer?
I made the following suggestion to a group claim managers many years ago; "Do away with the 24-hour contact rule and implement an IMMEDIATE contact rule. Then, follow this up with an immediate, cost-effective investigation". Heresy!
Sadly, many investigations today consist of a conversation with an injured worker. This process is tantamount to believing everything a used car salesman tells you about the 1977 Pinto you have your eye on.
The medical case management element, when coupled with an immediate and thorough investigation, will pay dividends. It is not enough to assign a Nurse who PHONES the injured worker and the attending physician. Their impact is minuscule with this process.
Like politics, claims management can get bogged down in meetings, relationships (vendors), data management, on-line access and monthly reports. Progress is achieved when we get back to a focus on the injured worker, a swift and thorough investigation coupled with immeidate medical case management intervetion that is not afraid to call out a doctor when their treatment is not substantiated by findings.
Carom has developed both the investigation and medical case management methods and services that bring to light, quickly, all the elements of the disability (physical, emotional, financial, vocational and motivational) to ensure better (lower) outcomes.
Visit http://www.caromdata.com/ for more information.
