[This is the second part of a discussion on the Disability Insurance “trust gap”. It is based on notes and discussions points for sessions in a 4th year Disability Management course on Workplace Insurance and Benefits. Part 1 explored the reasons for the lack of trust in disability insurance. Part 2 provides three general suggestions for organization and five practice priorities individual case managers and disability management professionals can use to narrow the trust gap they face in their day-to-day work. ]
In the last
post I highlighted the trust gap in the insurance sector and some of its causes
in the disability insurance sector. That
sector includes workers’ compensation, group Long Term Disability (LTD),
transport accident compensation and rehabilitation among others. This post
focuses on what individual case managers, vocational rehabilitation
consultants, return-to-work coordinators, and other disability management
professionals can to do narrow that gap.
The goal of doing so is to achieve better outcomes for the disabled
individuals we serve.
Minding and
mending the insurance trust gap
That trust
gap doesn’t make your job as a case manager working in any disability insurance
system any easier. Coupled with the complexities of systems, workload demands,
and resource issues all knowledge workers face, case managers you must find a
way meet the expectations of your own organization and the needs of those you
are trying to serve. You may get a lot of advice on how best to do that. Despite your efforts and the best intentions
of insurers, that gap is not going to magically disappear.
For
Organizations:
Ultimately,
every disability insurance insurer needs a strategy to narrow the insurance
trust gap. Unfortunately, few organizations
bother to measure trust at all.
Every
organization should measure the level of trust stakeholders, claimants, and
others have in their organization. This
is particularly important among those seeking benefits. It is possible for someone who has an
accepted claim to still assess their level of trust as low. It is also likely that those with denied
claims will have lower trust, but it is also possible for a denied applicant
for benefits to have trust in the processes and reasons for the denial.
It is
particularly important to identify and track applications that are driven by
other insurers. It is possible that the
efforts of other insurers to leave no other avenue of coverage unexplored may be
detrimental to your levels of trust and overall reputation. Understanding this dynamic is critical to anyt
strategy for narrowing the trust gap.
Compare
your organization to others. This may mean
agreeing with competitors, parallel organizations, or industry associations to measure
trust in similar ways and with similar regularity. We know the financial services has a trust
deficit; pinpointing your organization’s
particular trust status is essential to developing and implementing a strategy
to improve it.
Narrowing
the Disability Insurance “Trust Gap” for
DM professional, Case Managers
Knowing
that gap exists means you can do something about it. How you interact with those you serve can
narrow that gap and improve both service and outcomes. Here are five things you can do every day. This guidance comes through my interactions
with injured workers and disabled clients over the last four decades. Focusing on these priorities won’t eliminate
the trust gap but can help you narrow it on a case-by-case basis.
Attend
Believe
Communicate Clearly, Concisely
Act with Dispatch, a sense of Urgency
Develop genuine Empathy
Follow through
I’ll expand
on each of these ideas but realize these are independent of any corporate
initiative. These priorities are within
the power of every case manager, vocational rehab consultant and DM
professional in the disability insurance field.
Attend.
Attending
means more than just showing up to a client meeting, passively listening to
them on the phone or skimming the latest medical report. Yes, your job is complex but just about every
job today is complex. The circumstances giving rise to injuries are almost
always complicated.
What
injured and disabled clients want is more than a series of random contacts repeatedly
asking to be told the same story or continually explain the details that gave
rise to the injury. It is not only
frustrating, but it can also be harmful. It may be easier for a new case
manager taking over a case to ask the beneficiary to re-tell their story, but
this is often just a shortcut to avoid reading the detailed information already
on file.
Some
insurance organizations have increased caseloads of case managers or transitioned
from early and direct service by specialist professionals to highly systematized, volume-focused,
script-driven, front-end generalist at distant
call centers. Reaching and maintaining
contact with a knowledgeable specialist case manager or DM professional is
often difficult. Where part of a
segmentation strategy to stream cases to a specialist professional, the upside
benefits for the client may be positive.
Unfortunately, these models are sometimes introduced as corporately necessary
to address cost or staffing needs and may come at a significant cost to the
injured individual seeking help. Continuity
of contact over longer duration disability cases can reduce gaps in
understanding and build trust.
Actively
listen to your clients. Wherever
possible, reduce handoffs to others. It
you must hand off to someone else, be sure to reflect the client’s situation
and concerns fully, preferably personally.
When with a client, that person should be the only person that matters
(phones and email alerts should not distract from your attention).
Believe.
The clients
you encounter are overwhelmingly sincere.
Believe them.
Start with
a mindset that people seeking benefits from a social or personal injury
insurance plan are sincere and not trying to “rip off” the system.
The
incidence of claims fraud across all property and casualty insurance lines in
the Americas is estimated at about 1.38%.
[see Reinsurance Group of America, RGA 2017 Global Claims Fraud Survey
available at https://www.rgare.com/docs/default-source/knowledge-center-articles/rga-2017-global-claims-fraud-survey-white-paper---final.pdf ].
Personal
injury insurance and disability plans are not rife with fraud. A favorite target of the rampant-disability-benefit-fraud
myth is the US Social Security Disability Insurance system (SSDI). Despite spectacular rhetoric about fraud,
repeated internal and independent reviews have shown “the level of fraud in the
disability program is less than one
percent…” [see Statement of Carolyn
Colvin, Acting Commissioner, Social Security Administration, Hearing Before the
Subcommittee on Social Security of the Committee on Ways and Means U.S. House of
Representative JANUARY 16, 2014, Serial
No. 113-SS09].
Adjudicating
and administering personal insurance cases is not easy. It requires expertise,
judicious weighing of evidence and experience and adherence to complex law,
policy, jurisprudence, and procedure. Asking
for information is diligence; repeated requests for previously provided
information infers disbelief.
Consider
the actual necessity of what you are asking and how your request may be
received. Even if your requests are
procedurally required, the client’s reaction to yet another request for more
medical evidence or medical examinations may be quite different. Your request
for more (or, worse, already provided) information may communicate something
between skepticism and outright an outright accusation of malingering. Not a great way to build trust.
Start from
a position of belief. If circumstances
or evidence on a particular case lead you away from that position, of course
you must act accordingly; know, however, that such cases are rare.
Communicate
clearly, concisely.
We all have
insurance policies of one sort of another, but few of us have read the fine
print… or, having tried, are often left confused by the nuances of
restrictions, exceptions, and exclusions common in almost all insurance plans.
The
technical nature of personal injury insurance creates ambiguities and
information asymmetries. For someone with a new disabling condition, injury or
disease, the whole insurance experience is new and layered on the pain,
suffering, and fear that typically come with disability, For the case manager,
every new application for benefits is another of many in a very technical,
policy and procedure driven system.
The very
nature of insurance—the transference of specified risk of loss from the
policyholder to the insurer— makes these complexities inevitable. What is not
inevitable is the confusion from the way policies and decisions are
communicated. It is easy to rely on the direct wording of the law or policy; it
is much harder to communicate clearly without excessive reliance on legalese.
Strive for
clarity in all your communications—verbal and written. Canned paragraphs and
templates are necessarily vague. Be certain your communications apply exactly
to your purpose. If a standard letter
does not work well, modify or abandon it in favour of something that better
communicates your purpose, decision or needs.
Work with Dispatch.
“The
waiting is killing me!” “What’s taking so long?” I’ve heard these exact words
countless times. In an age when you can get an insurance quote with a click or
keystroke, it is more than ironic that getting a decision on a benefit request
can routinely take three to six weeks.
According
to one source,
“…these [are the] ideal response times in the insurance industry:
Emails: within an hour
Chat: 5 minutes or less
Live chat: less than a minute
Phone calls: less than 30 seconds”
[See The importance of response times in the Insurance Sector (2023 Guide) - timetoreply available at https://timetoreply.com/blog/the-importance-of-response-times-in-the-insurance-sector/ ]
There are legitimate
reasons for delays in all disability insurance administration; medical and
incident reports are not filed on time, critical staff are on vacation or in
training, medical diagnostics are hard to access. The automated mantra of “We are experiencing
higher than expected call volumes” is often used to hide staffing issues,
system deficiencies, and intentional but undeclared decisions to simply live
with delays and subsequent frustrations as the status quo.
Transparency
of standards and constant public updating of performance may increase
accountability and reduce wait times for decisions and payments. Few organizations publish this sort of data
on a routine and timely basis.
Recently, a
disabled employee recovering from a surgery applied for benefits form her
private insurer. After weeks of delay,
she received an email request for additional information, which she provided
the same day only to receive a response that the adjuster was going away on
vacation and would make a decision upon her return. Don’t do that.
Regardless
of the system constraints, you have the power to do your job. If there is something that needs to be done,
do it! Do it now!
Empathize
You know authentic
empathy when you experience it. An
empathetic person has emotional intelligence—knowing and understanding another
person’s perspective. Fully attending to
another is one thing; being able to see the world from their perspective is
something else, something every case manager and DM professional should strive to
do.
Develop
genuine empathy. I don’t mean sympathy
and definitely not pity. Repeating
platitudes like “I hear you” or “I’m sorry” is not what I am talking
about. Empathy is deeply understanding
and identifying with the context, emotions, frustrations, and aspirations of
another.
Follow
through.
If you say
you will send out a decision letter today, then do so. Remember, even a negative decision is often
essential to access another benefit.
Saying you have made a decision and even telling someone is not enough
in most cases.
If you work
in DM, HR, or CM for an insurer, you will have to follow the rules of your own
organization. Those rules are unlikely to conflict with acting to reduce the
frustrations of those seeking their benefit entitlements. Never be the reason for delay. If delays are becoming systemic elsewhere in
the process, seize the initiative to expedite or resolve the issue. At a minimum, raise the issue with those who
can fix it.
Where there
are follow-up or review points in a return-to-work plan, for example, make them
explicit, and actively monitor those review points with direct contact with the
client.
Final
thoughts
The
insurance “trust gap” will be a continuing factor in your work. The best a professional Case Manager, Disability
Management Professional, Adjudicator or Return-to-Work Coordinator can do is to
narrow that gap with each new case, each client you encounter. Focusing on these five themes will help you do
just that.
