Roger was the most knowledgeable worker's compensation claims person I ever met. He knew the labor code; he knew all the case law and how each legal opinion applied to that claim which was in his hand. He knew how to accurately and consistently reserve claims (he was exceptional with this), he knew how to audit claims, and he knew how to resolve claims. Roger was not very tactful. He…
Introduction Within all claims operations, the claims manager and supervisor are responsible for balancing the examiners’ caseload to make sure that the examiners not only have the right caseloads but also have the right claims within that caseload. Properly done, the assignment process will allow the examiner to produce optimum results. The right balance is based on the experience of the examiner, the support level of the claims team (number…
Introduction The “Optimum” throughput of claims always results in the lowest total cost of claims. Instead of focusing on caseloads the industry should focus on the throughput of claims to measure productivity and staffing needs. Optimum throughput of clams is; When claims are immediately reported, where compensability is promptly determined, when prompt appropriate medical care is provided, when early return to work is achieved, where indemnity benefits are accurately and…
Employers have a direct positive impact on their claims results if they partner with the claims examiners. When employers treat the claims examiner as a professional partner, claims results are always better. When employers work well with the claims examiners the examiners are happier and more productive. Employer actions also have a direct impact on examiner retention. In an industry full of negativity, acknowledgements and thank you notes to examiners…
Every job in the insurance industry requires good negotiation skills. It remains a mystery to me that few in the insurance industry are formally trained in the art and nuances of negotiations. Each job has its unique nuances and language. There should be a specific training program for the sales staff, the underwriters, the safety professionals, the clams examiners the attorneys and the medical professionals. Here are a few negotiations concepts…
There are many different life situations facing parents. One of the most rewarding and challenging is the balancing act of raising children while meeting work responsibilities. The fundamental obligation of a parent is to make sure that their children obtain the necessary education to be successful in life. Children who are engaged and supported at school usually become successful adults. Many times employers ignorantly create work situations that do not…
One of the biggest challenges that our society will experience in the next generation will be to transition from human driven cars to autonomous vehicles (AV). One only has to listen to the Beach Boys to understand the deep relationship that most of the American public has with their automobiles. Cultural resistance to implementing autonomous vehicles include concerns over hackers, loss of a pleasurable experience, the perceived need for control, and…
Introduction Teflon and the first 100 days. Everyone who starts in a new company or gets a new role is given an allotment of “teflon” when they start. This “teflon” usually is in the form of deferential treatment, and latitude to do new things and make mistakes. Starting a new job can be both exhilarating and overwhelming. In this period of transition, one invaluable tool that can set you on…
For your reading pleasure, I have attached several articles on the internet of things (which I call “The Internet of Everything”) and an article on a cyber-attack on the cloud; which used "the internet of things" as a platform for the attack. I miss my old “birdcage” refrigerator but, when I am in the grocery store, (Safeway) I sure like looking inside of my new refrigerator to determine just how…
The sense of self-worth, value and identity are closely associated with that person’s job or occupation. Everyone needs an adequate income to survive. Everyone wants to be a part of something bigger, be valued for their contributions, be a part of a community. Work provides these and more. That is why it is much more than just an economic catastrophic event when someone loses their job due to a work-related…
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