Advocacy Thoughts with Insight for a successful Claims Approach.

In today’s society modern technology is at the heart of most companies and plays a vital role in daily operations. However, Claims Advocacy operates on a totally different approach. Companies need to learn, and understand how utilizing empathy early on with claimants will yield more dividends then ever expected providing positive results towards resolution. There is enough sufficient data today in the industry that supports the advocacy approach. 

What is the meaning of Claims Advocacy? Ask ten people and you may receive ten totally different views. 

Fully understanding the mindset of a claimant is extraordinary difficult unless you had the direct experience of navigating your own claim prior. You must be able to put yourself in the claimants shoes. My best analogy, if you were to buy a McDonald’s franchise having all the resources in place, you still need to be accepted and attend hamburger university. This complex training program is designed learning how to owner operate a store from all levels. This long term training is a required learning approach teaching every position within a store before being granted a franchise. Understanding all sides of a business model provides the tools required to be successful. Being a past claimant personally for over six years, along with my in-depth training and education, has provided me a very unique insight and overview of a system with many moving parts on how to identity, anticipate, and resolve issues by utilizing a specialized claims advocacy risk management approach with early intervention protocol.

Imagine this, being injured on the job, not familiar with the process, not knowing when your next disability check will arrive and how you may provide for your family all while feeling ill. 

The human element is one key factor that begins the claims advocacy process. Treating someone as a person, Joe/ Jane Smith for example and not file number 101 makes a tremendous impact from the very onset of a new claim. Obviously not utilizing industry terms with claimants will help. Speaking in plain English while being upfront with a claimant will always go further then you may think from the start of a claim.

Don’t take a claimant for granted and explain the process in detail from day one with answering any and all questions or offering assistance shall any need arise. The time to stop and reduce litigated Claims is prior to the start. These simple implementations by the adjuster may help with the breakdown in communication that lead to ligated claims.

Having examiners or case managers try to preform the empathy function when they have been trained prior in the exact opposite protocol will not produce the most desirable results without re-education and training on how to engage a claimant with an advocacy model mindset. When a breakdown in communication with the claimant arises and the claim is ready for resolution, adjusters begin to utilize defense counsel as a crutch. This again is not the adjusters fault, just having over 100 files on their desk at any given time is a catalyst for this approach. The claim begins to be drawn out while administrative costs continue to rise. A claimant now sees a defense counsel or adjuster as an adversary while a neutral party is scene as an advocate for resolution in a non-adversarial type of manor. Every claim has numerous opportunities for early resolution but must be identified within a risk advocacy management approach model

Stop tripping over dollars to save pennies!

Companies invest vast resources for the education and training of employees yet the industry has demanded a less adversarial approach and changing a persons title without the re-education or foundation for effective communication with an advocacy approach may not achieve the desired results. 

Utilizing a True Strategic Partner that is invested for the clients success who works in collaboration as an extension of your own risk management team to find an amicable resolution for all parties. The best thing you can ever do for a claimant, help them return to work and resolve their claim as fast as possible.

Managing the cost of Workers’ Compensation Claims begins with the approach. 

Paul Gold

Founder & CEO

PG Resolutions Group