A question I put to CFOs and VPs of Claims: what does it cost your organization when an adjuster handles a claim without the clinical and procedural grounding to do it well? Most cannot answer with a number. They can describe the symptoms. Reserves that drift. Claims that stay open longer than they should. Files that escalate to litigation for reasons nobody can quite explain after the fact. What they…
Every training budget review starts with the same question. What did we get for the money? Most learning and development teams answer it with the wrong data. They report how just many adjusters attended, how they rated the session/training provided, and a completion percentage pulled from the learning management system. None of that tells the CFO whether the training changed anything that eventually shows up on a loss run. This…
Ask a CFO what a claim costs and you will get a number pulled from the reserve system. Ask what a claim costs when it is reported three weeks late instead of the same day, and most CFOs cannot answer. That gap is worth closing, because the answer is large, measurable, and directly tied to something the organization controls: how well the front-line supervisor is trained. The data on reporting…
Every claims organization I work with has a technology budget line and a training budget line. In most budget meetings, the technology line wins the argument almost by default. New software has a demo. It has a dashboard. It photographs well in a board presentation. Training does not have any of that, so it gets treated as overhead and trimmed first. I want to walk through why that instinct, reasonable…
Every claim organization has run this math at some point. A senior adjuster leaves. The open requisition sits for weeks. A new hire finally starts, spends the first six months learning the file types, the jurisdictional rules, and the carrier's own claims philosophy. Somewhere in that gap, claim drifts. Reserves get set late. Litigation rates creep up. The organization pays for all of it twice, once in recruiting cost and…
How Spinal Fusion Can Create New Complications Several weeks ago, I wrote about two of the most dreaded words in workers’ compensation. The words “spinal fusion” can represent a significant problem in addressing workers compensation cases. With the assumption that the need for a lumbar fusion has been adjudicated, and the perceived need is a function of the compensable event, one must realize that in an effort to address these…
Why Claim Resolution Often Goes Off Track Obtaining a resolution for a compensable injury is the ultimate goal of every workers’ compensation professional. However, the path to closure is rarely a straight line. Between clinical hurdles, occupational rehabilitation issues, and administrative friction, the process is often bogged down by “tangential factors” that distract from the primary objective. A key component of this process is establishing a return-to-work (RTW) plan in a manner…
A framework for making education spend defensible, not discretionary Training budgets get cut first. Not because they matter least, but because they are usually presented as if they matter least. When a budget staffer or committee is trimming for the year, discretionary line items go before core operating costs. If professional education shows up in your budget package as a discretionary line, it will be treated as one, regardless of…
A Line-Item Breakdown Adjuster turnover tends to get filed under human resources. That is a mistake. When a trained claims adjuster leaves your organization, the financial damage does not stay in the HR budget. It spreads across your loss ratio, your reserves, your litigation rate, and your claim duration numbers. It shows up everywhere except the place where you were looking. CFOs and VPs of Claims routinely underestimate the true…
I am not sure why this popped into my head, but I was thinking about a song from the mid-80s from Dire Straits, the song “Money For Nothing” in the first line (and I will take the creative license with the lyric) “Money for nothing and your ‘checks’ (my bad) for free.” It seems a frequent consideration that a percentage of work comp claims are perceived as being embellished, fraudulent,…
