Jan 19, 2010

5 Deadly Sins of Claims Management- Part 2 of 5

This is the second in our five-part series on disability industry claim management practices. We hope you'll find it worth the 4 minute read and share it with your colleagues.
Category: From the Salt Mines
Posted by: ibecadmin

Welcome to Salt Associates

Since 2003, Salt has been performing disability claim audits and reviews, claim data analyses, claim operation reviews and consulting to disability insurance companies, third party administrators, disability reinsurers and large employers¹. We've seen the good, the bad and the ugly. Recognizing that no one is perfect and understanding the complexities of managing claim operations in this day and age, we continue to find elementary claim management techniques missing. We call them The Five deadly Sins:

 

  1. Timeliness
  2. Use of the Telephone
  3. Use of Risk Management Tools
  4. Written Communications
  5. Something we call "Risk Management Critical Thinking"

 

1 Based on over 80 claim audits and reviews in 31 different claim operations.

5 Deadly Sins of Claim Management

 

Based on our findings from disability claim file reviews and the data collected in our proprietary claim audit application, here's our take on use of the telephone in the disability claim management process:

 

The Telephone

In some claim organizations, using the telephone has sadly become a lost art.  In other organizations, using the telephone has never been implemented.  We worry that there is a generation coming along that has no telephone skills - for any purpose. Everything is Tweeted, texted and Face booked. Social networking apparently does not include the telephone. To actually speak on the phone with someone intimidates them.  The industry may need to provide more, not less telephone training.

We strongly believe that the telephone is one of, if not the most effective risk management tools in the tool bag. Using the good old fashioned land line and talking with claimants, employers, and physician's offices is good practice with proven results. Talking and listening establishes rapport, engages the claimant - well, you've heard them all before. The debate over whether or not it saves time and reduces durations and all those positive outcomes will go on. Regardless, in many claim situations, the claimant deserves a call. We don't touch our customers enough. It is the right thing to do.

Areas we focus in our claim and operational reviews include:

  • Initial Claimant Interview
  • Discussions with Employers and Doctors
  • Ongoing Telephone Contact with the Claimant
  • Communicating Decisions or Changes in Status

Examples of what we've seen include:

  • Only 33% of claims had a claimant interview documented in the file
  • The phone is the primary communication tool approximately 16% of the time
  • The attending physician was contacted directly by phone only 4% of the time

Actual Audit Example:

In a sample of 300 LTD claims, a claimant interview was done on only 21% of the files.