Tag Archives: adjuster

Reconnecting With Customers Via Claims

While every carrier manages claims operations in a slightly different way, there are three consistent technology setups currently in practice: Green Screen, Home-Grown and Modern. The back-end operational workflows for each of these practices are generally the same: The adjuster manually enters notes, manually sends emails or makes calls and manually ties documents from the document management systems to the claim systems. The challenge here is that the adjuster is the centrally intelligent component. Relying on an adjuster to connect various systems mires the adjuster in overly manual steps, leaving claims processing vulnerable to reduced speed, mistakes and inefficiencies – all of which lessen customer satisfaction.

Green Screen

While more common overseas and in smaller markets, green screen systems are still found in many claims operations today. The green screen is a simple claim database that only accepts user inputs from a text-based screen with minimal capabilities to integrate into any other systems. Adjusters are forced to use a separate document management system to store files and photos and use a separate email system for outward communications.

Carriers relying on green screen systems see inefficiency with data transfer. Adjusters have to hunt for documents that are not tied to a claim number, annotate the decisions they have made in the green screen system and communicate in a separate system to the customer. Most of the mindshare of the organization is spent on teaching the humans the rules of the claim and how to document their thoughts in the system.

See also: Visual Technology Is Changing Claims  

Home-Grown

Some organizations have managed to build their own systems internally over the years. In these systems, various IT projects over the years have been spliced together with complicated business rules that aim to reduce the human error and ensure legal compliance. Carriers with a home-grown system face significant IT spending to maintain their complex infrastructure. Even with a large IT staff, it is nearly impossible to launch new technology initiatives because change affects rules buried deep in the system. The result is a system that is expensive, inflexible, complex and generally oblivious to the customer experience.

Modern

Recently, carriers have consolidated their legacy systems into one modern platform. These setups require a large engagement with a third-party system integrator and many years of thoughtful planning and data migration. However, the output is rarely a truly consolidated system. Carriers with modern systems are bound to long-term, third-party support contracts and face many of the issues that home-grown carriers face. Complicated business logic is embedded in the software to try to avoid human errors, but it leads to complexity and rigidity that ensure internal compliance while ignoring the customer experience.

Carriers and Customers

As customer needs are changing, carriers’ technology should be changing, too. Today’s customers expect a seamless tech experience with clear communication, automation and the ability to input via apps, photos, phones and inboxes. There are several new tech solutions that aim to ease a challenge of current carrier tech configurations. At Snapsheet, we have already built software that eases nearly all of these customer expectations.

Here are the capabilities that are critical to advanced claims technology – all of which will help meet customer needs:

  • Cloud-Based Architecture: This feature is important for a flexible design, which eases the implementation. There is no data migration, no system integration and no multi-year project plan. Claims software is launched stand-alone around existing systems or as a full-on replacement. It enables carriers to track, with real-time precision, all of the customer interactions, how the customer engages with the claims process and how the adjuster is engaging with the customer. Immediate insights are gained and can be operationalized.
  • Intelligent Claims Files: Instead of relying on the adjuster to tie systems together and shepherd the customer through the claims process, the Snapsheet platform has advanced capabilities that understand the expectations of each step in the claims process and guide the customer through the appropriate actions. An intelligent engine coordinates the communications and documentation needs for each file and advises the adjuster when to take action. If all of the requested information is provided, the engine may choose to automatically move the work to the next stage.
  • Real-time metrics and operational transparency: It enables the carriers to track, with real-time precision, all of the customer interactions, how the customer engages with the claims process, and how the adjuster is engaging with the customer. Immediate insights are gained and can be operationalized. The result is an enhanced customer claims experience, led by automation and real-time customer engagement to provide a tailored journey through any claim in any language in any country.
  • Customized roll-out: Customization is key. Even with a single consistent platform, such as Snapsheet’s, it is important to customize implementation for whatever legacy IT configuration exists. This adds flexibility and ease-of-use to each project. Snapsheet’s recent strategic collaboration with Zurich is an example of taking a new software approach by putting the customer experience first. Various county entities in Zurich use each of the three software setups mentioned above. Snapsheet software can be leveraged across any configuration, activating software modules that smooth or plug efficiency gaps in the current process, or completely replace existing claims systems.

See also: How to Use AI in Claims Management  

As we kick off 2019 and insurtech continues to expand, the industry will see even greater advancement in the technology space for carriers and claims processes. Automated systems are important to guide the customer through the correct claims journey and ultimately allow carriers more time to innovate.

Telematics: A Claims Adjuster’s New BFF

Nobody can have too many BFFs (that’s best friends forever in today’s texting-driven vernacular).  That statement goes double for claims adjusters who are frequently seen as “bad guys” because of all the difficult-to-understand complexities of the adjusting process. The reality is that claims adjusters do not get enough recognition for the many times they go the far distant extra mile to help a customer after an auto accident. Claims adjusters need all the tools they can possibly get to deliver customer service at the high levels they want to deliver. And telematics is here to the rescue!

Many insurers see telematics only as a new way to rate auto insurance coverages, perhaps even replacing traditional rating criteria as some InsurTech innovators are doing. Other insurers only see telematics as a new way to underwrite auto policies, replacing traditional and sometimes complicated criteria with usage-based facts. These are all real situations. But what most insurers do not yet see is that telematics can be a way to give claims adjusters a customer service tool that, incidentally, improves claims financial outcomes. And who doesn’t love a win-win!

See also: Telematics: Moving Out of the Dark Ages?  

A new claims adjuster, right after getting a company ID badge and signing up for company benefits with HR, learns that the sooner the company is advised of a claim, the better the odds are the company can assure a successful outcome and control costs. That’s Claims Adjusting 101. Many insurers have addressed this by directing the first notice of loss from the consumer through a company contact center or service provider. More recently, companies have developed FNOL apps for mobile devices so that claims reporting can kick off shortly after paperwork is exchanged at the site of the accident. But, what if the FNOL could be generated as the accident happens? As a matter of fact, state-of-the-art telematics can actually do this.

Leading telematics technology can generate the FNOL from the actual impact dynamics. Appropriately implemented, this means that an emergency medical response could be automatically initiated if the impact details warrant it. In the event of a serious crash, this could make a critical difference in treatment outcomes. Towing services could also be initiated, getting the vehicle off the roadway sooner. Body shops and storage facilities could also be looped in as appropriate. Being the technology-enabled “first on the scene,” and providing much-needed assistance at a stressful time puts any claims adjuster on the fast track to BFF status. And, returning to Claims Adjusting 101, it helps with the positive management of claims costs.

The benefits of telematics in auto claims adjusting don’t stop there. Telematics can provide factual details that sometimes elude those involved in the event. When asked what happened, those involved in the accident very frequently respond with “it all happened so fast.” Telematics facts can replace post-loss perceptions of the event, thus helping the adjuster move the claim along faster. The telematics-defined dynamics of an accident can also aid in injury assessment, again, moving the claim process along.

There’s more. Vehicle repair can be an arduous process, particularly if the damage renders a vehicle unusable. Not having a car is clearly a source of frustration for most individuals. Simply getting all the assessment details can hinge on visual inspections, reports, and sending photos. Telematics can provide impact details and dynamics that can speed this process along, leap-frogging traditional claims processes to reunite vehicle and driver sooner. Another BFF moment!

In my role, I have spoken to a great number of claims executives. I have yet to meet any who did not see themselves and their organization as a key driver, if not the number one driver, of customer satisfaction. There are a good number of tools that claims organizations possess to deliver excellent customer service. And you can never have too many customer service capabilities (just as you can never have too many BFFs). Insurers should assess their existing or newly planned telematics initiatives and expand the opportunities for value and customer service beyond rating and underwriting to claims operations. Many technologies benefit one product line, or one discipline, or one process. It is, indeed, a top priority technology initiative that can span the organization at many levels, improving customer service and bottom-line results simultaneously. Telematics should be on the short list.

See also: Lessons From New Telematics Firm  

For additional thoughts on how telematics can be a successful component of an anti-fraud strategy, please read our blog Fraud is Not a Cost of Doing Business – And Emerging Tech is Here to Prove It!

medical

New Tool for Settling Open Medical Claims

The almighty dollar is often just one component of a successful workers’ compensation settlement. Savvy negotiators recognize that they have several tools at their disposal when it comes to bridging the gap between the payer’s offer and the plaintiff’s demand, many of which dictate how and when the settlement dollars can be used.

On both sides of the negotiating table, many are adept at minimizing or maximizing the medical cost projection or the amount that goes into a Medicare Set Aside (MSA). Many in the industry also understand how a structured settlement (annuity) can unlock value and allow for the pacing of stable income for the claimant.

Now, a small but growing number in the industry are beginning to understand how offering professional administration (PA) of the claimant’s future medical funds can help facilitate a settlement. PA provides the claimant with a dedicated support team after he settles the case, along with technology to ensure he saves money when he actually spend the settlement dollars on healthcare.

What settlement issues can you use PA to help address?

The most often cited concerns of injured workers when they face the prospect of settling are regarding: 1) access to their medical treatment and 2) how long it takes to get a response from their adjuster, attorneys or the board as they go through settlement process. Examples of these concerns are easily found by reading the comments directly from injured workers in a survey by the New York Workers’ Compensation Board. Issues like “denied treatment” and “delayed processes” are at the core of nearly every complaint.

PA is effective in addressing these concerns because PA services do not restrict the claimant’s access to medical treatment via utilization review or a medical provider network (MPN); PA services provide expanded choices for treatment. In addition, many PA services have call centers that offer support to their clients, the injured workers. CareGuard, for instance, offers 24/7 coverage to its members and prospective members to answer any questions they may have as they navigate the complex healthcare maze after settlement.

Through the life of their claim, many injured workers simply lose trust in the attorneys, judges or system in general. This is often because the settlement process sets the parties up at a table for purposes of a one-time transaction, but then each group walks their own separate way.

There is sparing research done on injured workers’ attitudes toward settling their case, but a survey in Minnesota in 2013 scratched the surface of what a daunting undertaking settling is for the injured individual. The study found that about one-third of injured workers did not fully understand their settlement. Further, it revealed that around three-quarters of injured workers did NOT believe they achieved a “fair” settlement. The sample used were folks who actually overcame their concerns and settled regardless of the negative sentiment the process evoked. Many claimants do not have the courage to push forward with settlement and instead decide to leave their future medical claim, if not their entire claim, open.

PA can be a valuable tool, whether for adjusters, defense attorneys or plaintiff attorneys, to inject trust and solutions into a contentious situation. A team becomes available to address claimants’ concerns about their future medical treatment. PA also introduces a party to the settlement negotiation whose interests are aligned with the claimant’s, because the PA provider will be the only party continuing to provide service to the claimant after settlement. This can give the claimant much-needed peace of mind that a partner is looking out for his best interests, and it is this peace of mind that helps reluctant claimants see that settling could in fact be their best decision. PA services give claimants comfort and confidence that life after settlement can be a rewarding and hassle free experience.

How can you leverage PA in a settlement?

To leverage PA effectively, negotiators on either side of the table should introduce the service early on in the process and clearly explain its benefits to the claimant. Often times, it’s useful to connect the PA provider directly with the claimant or her attorney so that a relationship is established and the service is well-understood. After all, the agreement between the PA provider and the claimant will exist for years beyond the settlement; it’s better to begin that relationship early on rather than try to throw it in last minute.

The PA provider can serve as a neutral party that helps explain to the claimant what she can expect after settlement. Some PA providers, like CareGuard, can go further to provide cost analyses of what treatments will cost on their platform and demos of how their service works. PA providers understand that they do not get paid until the case settles, so they are a source of information and guidance toward settlement for all parties involved.

Jurors and Questions on Insurance Coverage

For most potential jurors, questions of insurance coverage do not usually arise in common conversation. Seldom cut and dried, usually subject to numerous definitions and intricacies, coverage issues can be boring and puzzling for even an experienced adjuster. Asking a lay person to try to classify an “occurrence” as defined by a policy, or whether a third party is covered as an additional insured, may prompt, at best, glazed-over eyes or, even worse, a negative commentary about insurance companies. While it may be best in some situations for a judge to determine the issue of insurance coverage, this is not always possible. Sometimes, coverage questions arise in litigation, and those interpreting policy language and determining the outcome are jurors. If jurors are deciding the issues, certain challenges then arise, such as how to clarify policy language, present a clear and concise argument and overcome negative preconceptions about the insurance industry.

Can the Judge Decide Coverage Issues?

In Louisiana, general rules regarding issues that are triable by a jury are set forth in Louisiana Code of Civil Procedure articles 1731 – 1736. These establish the general rule that a demand for a trial by jury will result in a trial by jury of all issues. However, exceptions to the general rule exist when: (a) the parties stipulate that the jury trial shall be as to certain issues only; (b) a party in his demand specifies the issues to be tried by a jury; or (c) the right to trial by jury as to certain issues does not exist. Where a jury trial has been demanded by one or both parties, the case must be tried by a jury unless both parties consent to trial without a jury or the trial court finds that a right to a trial by jury does not exist.

More particularly, La. C.C. P. art. 1562(D) specifically codified the general principle found in La. C.C. P. art. 1736 requiring a stipulation between or the consent of the parties before the trial judge can order that insurance coverage issues be tried separately, with the “court alone” deciding the issue of insurance coverage.

La. C.C.P. art. 1562(D) states:

“If it would simplify the proceedings or would permit a more orderly disposition of the case or otherwise would be in the interest of justice, at any time prior to trial on the merits, the court may order, with the consent of all parties, a separate trial on the issue of insurance coverage, unless a factual dispute that is material to the insurance coverage issue duplicates an issue relative to liability or damages. The issue of insurance coverage shall be decided by the court alone, whether or not there is to be a jury trial on the issue of liability or damages.”

The leading case on the subject is Citgo Petroleum Corp. v. Yeargin, Inc., 95-1574 (La. App. 3 Cir. 7/3/96), 678 So.2d 936, writ granted, remanded, 96-2000 (La. 11/15/96), 682 So.2d 746 and 96-2007 (La. 11/15/96), 682 So.2d 747. There, the court stated that La. C.C.P. art 1562(D) provided that, if principals of judicial efficiency or justice would be served then the court may order a separate trial on the issue of insurance coverage. However, the trial judge’s discretion is not unfettered. The judge’s ability to take the issue away from the jury is severely restricted because, under the article, all of the following conditions must exist: (1) it would simplify the proceedings, permit a more orderly disposition of the case, or be in the interest of justice; (2) the consent of all parties; (3) the non-existence of a factual dispute material to the coverage issue that duplicates an issue relative to liability or damages; and (4) the order must be rendered before trial on the merits.

Therefore, the requirements set forth in the article effectively leave the judge with no discretion, as it requires the consent of all parties. The court further noted that, while the issue of insurance coverage under an insurance policy is a narrow issue of the law between the alleged insured and the insurer, a jury is not prohibited, by statute or otherwise, from deciding this issue. Further, there is no exception to the right to trial by jury for issues that the trial judge may think are too technical or too complex for the jury to understand. Even if the trial judge believes that he is more capable than the jury of deciding the issue of coverage, he cannot take this issue away from the jury once the issue is included within the scope of issues for which a jury trial was requested, unless the conditions of La. C.C.P. art. 1562(D) are met.

As such, if a trial by jury has been requested, but an insurer is presenting technical questions of coverage and believes that a judge would be best suited to decide the coverage issue, a stipulation or the consent of all parties would be necessary before the judge could take the coverage issue away from the jury. Unfortunately, often the consent of all parties to separately try the coverage issue cannot be obtained, and the insurer is left with a jury to decide intricate and potentially costly coverage issues.

Selecting the Best Jury for Your Coverage Case

If coverage issues must be decided by a jury, the persons who make up that jury can make a difference in the outcome of the case. Questioning prospective jurors in voir dire about their current insurance policies and other contracts can provide some insight into how they view insurance companies and the potential for coverage. People often believe that they are “fully covered” under their insurance policies, and that insurers are large, prosperous companies that should be able to “help out” individuals. However, further questioning can reveal that potential jurors do understand that there are limitations as to what is covered under certain policies and what has been negotiated.

Questioning a potential juror about a policy he may currently have in place, whether that policy has a limit and if he understands that the insurance company would not be required to pay more than that limit, can show that the potential juror does understand some limitations to coverage. Additional questions may involve who the current policies provide coverage to and the limitations on that coverage. Even simple, and almost obvious, questions can help illustrate a potential juror’s understanding of coverage limitations. For example, discussing how an automobile policy might provide coverage for certain damage to an owned vehicle but would not cover general maintenance, oil changes or a monthly car payment can help provide insight into whether an individual may be able to understand the issues and be a constructive juror.

Additionally, general questions regarding the potential jurors’ opinion of insurance companies in general, personal claims experiences or inferences regarding insurers that the potential juror has taken from the media can provide insight into whether the potential juror might be favorable or undesirable from the insurer’s standpoint.

Presentation at Trial – Concise and Comprehensible

After a jury has been selected, helping jurors understand and follow the language and logic of the coverage argument is vital. The following tips may help simplify the coverage case and overcome obstacles when faced with presenting coverage issues to a jury.

1. Walk Jurors Through the Basics

Although often complex, insurance policies are simply contracts. They define a relationship between parties and outline who will do what, when and under what circumstances. Presenting the insurance policy as a simple contract, by identifying the promise between the parties and what each may receive in exchange for their promise, may help jurors be less apprehensive when approaching coverage issues.

A good place to start is with the basics of the policy and how it is structured. Discussing the declarations, insuring agreement, exclusions, definitions, conditions and endorsements allows jurors to get comfortable with the policy. After the policy and its purpose are explained, the specific provisions at issue can be addressed. An effective way to do this is by using demonstrative evidence, such as blowups of certain pages or Power Point presentations illustrating specific language and what it means. Presenting the policy through large exhibits helps break down the technicality for jurors and show that it is a logical and consistent contract.

Further, preparing an exhibit naming and listing the experience of all of the individuals who are involved in creating the policy, the claim investigation, adjustment and the coverage decision shows that time and thought of real individuals went into creating a well-organized document and making a well-thought-out coverage decision.

2. Humanize the Issues

Jurors often bring their own experiences to the courtroom and, sometimes, a bad impression of insurance companies. Further, oftentimes coverage disputes are coupled with bad faith claims, exacerbating the notion that insurance companies are malicious. To overcome these perceived notions and prejudices, it is key to humanize the insurer’s operations and show the jurors that real people have drafted the policies and handled the claims. Showing that the insurer is not just a large, faceless corporation, but individuals making decisions and doing their jobs, will help negate the insured’s presented image of an uncaring, profit-seeking business entity. While testimony from a vice president may be impressive, the agent who issued the policy or the adjuster who handled the claim may help put a more relatable face to the company.

Additionally, many insurers have adopted vision statements outlining a code of ethics or a commitment to the community. Using this at trial, and showing how the company is committed to its values or involved in the community, helps dispel negative ideas of an uncaring corporation.

Lastly, insurers should be careful about attacking the insured’s credibility or positions. While it may be necessary, the way this is presented to the jury can have a big impact and can erroneously further the negative ideas about the insurance company.

3. Show All Negotiations

Jurors will generally understand the concept of “you get what you pay for.” They know that if they contracted with their cable company and pay for only the basic channels, they do not get premium channels, such as HBO. It follows that jurors should understand that if underwriting documents or other evidence show what was discussed and understood between the parties, and this is reflected in the contract, this should be what governs. If evidence of negotiations is available, this should be presented to the jury. This concept may be particularly helpful in litigating commercial policies, where there is usually more negotiation, and in showing the application of policy exclusions.

4. Keep It Simple

As a general rule, the simpler the better. It is important to keep the insurance policy language from sounding too technical. Avoid overuse of legal terms and phrases, as this will only confuse jurors and may cause them to fall back on the generally accepted legal principle that “any ambiguity must be construed against the insurer.” A straightforward presentation, relying on only one or two strong coverage arguments, should be used. Presenting every argument possible is not always the best strategy, as this could bog down the jury and cause them to lose focus. When one or two key arguments are made, the case is tight and allows jurors to concentrate on the big picture, rather than trying to follow several moving parts.

Another tactic that may help bring the issues to a comfortable level is to compare the policy to other contracts jurors may have entered into. Outlining the limits and duties imposed by contracts that jurors may be more familiar with, such as a purchase agreement for a car, or a lease agreement for an apartment, may also help jurors realize that there are also limitations and duties imposed by insurance contracts, just like the contracts with which they are more familiar.

Additionally, working backward from the result being sought provides a road map for a streamlined argument and helps create a unifying theme throughout the litigation. Starting from the verdict form or jury instructions helps to keep concentration on the elements that need to be established or explained.

5. Apply Basic Jury Concepts

Basic concepts of persuasion, which apply to all jury litigation, can also be used effectively in a coverage case. Fairness must be stressed and run as a theme throughout the presentation of the coverage case. Jurors want to be fair and will try their best to do so. Additionally, any obvious weaknesses in the case should be addressed. Holes in the case, if not admitted to or explained, will create doubt.

Presenting a coverage case to a jury is sometimes unavoidable, but need not be too difficult or incomprehensible for jurors. Carefully questioning and selecting potential jurors, along with presenting a simple yet logical argument, while humanizing the insurance company, can help achieve a successful presentation of the case in the courtroom and, with that, a successful result.

How Bureaucracy Drives WC Costs

Workers’ compensation is one of the most highly regulated lines of insurance. Every form filed and every payment transaction is an opportunity for a penalty. Claims can stay open for 30 years or longer, leading to thousands of transactions on a single claim. Each state presents different sets of compliance rules for payers to follow. This bureaucracy is adding significant cost to the workers’ compensation system, but is it improving the delivery of benefits to injured workers?

Lack of Uniformity

Workers’ compensation is regulated at the state level, which means every state has its own set of laws and rules governing the delivery of indemnity and medical benefits to injured workers. This state-by-state variation also exists in the behind-the-scenes reporting of data. Most states now require some level of electronic data interchange (EDI) from the payers (carriers or self-insured employers). There is no common template between the states; therefore carriers must set up separate data feeds for each state. This is made even more complex when you factor in the multiple sources from which payers must gather this data for their EDI reporting. Data sources include employers, bill review and utilization review vendors. The data from all these vendors must be combined into a single data feed to the states. If states change the data reporting fields, each of the vendors in the chain must also make changes to their feeds.

Variation also exists in the forms that must be filed and notices that must be posted in the workplaces. This means that payers must constantly monitor and update the various state requirements to ensure they stay in full compliance with the regulations.

Unnecessary Burden

Much of the workers’ compensation compliance efforts focus on the collection of data, which is ultimately transmitted to the states. The states want this information to monitor the system and ensure it is operating correctly, but is all this data necessary? Some states provide significant analytical reports on their workers’ compensation systems, but many do little with the data that they collect. In a world concerned about cyber risk, collecting and transmitting claims data creates a significant risk of a breach. If the data is not being used by the states, the risk associated with collecting and transmitting it seems unnecessary.

Another complication is that there are multiple regulators involved in the system for oversight in each jurisdiction. Too often, this means payers have to provide the same information to multiple parties because information sent to the state Department of Insurance is not shared with the state Division of Workers’ Compensation and vice versa.

Some regulation is also outdated based on current technology. Certain states require the physical claims files to be handled within that state. However, with many payers now going paperless, there are no physical claims files to provide. Other states require checks to be issued from a bank within those states. Electronic banking makes this requirement obsolete.

How Is This Driving Costs?

All payers have a significant amount of staffing and other resources devoted to compliance efforts. From designing systems to gathering and entering data, this is a very labor-intensive process. There have not been any studies on the actual costs to the system from these compliance efforts, but they easily equate to millions of dollars each year.

States also impose penalties for a variety of things, including late filing of forms and late and improper payment of benefits. The EDI process makes it possible for these penalties to be automated, but that issue raises the question of the purpose of the penalties altogether. These penalties are issued on a strict liability basis. In other words, either the form was filed in a timely manner or it was not. A payer could be 99% compliant on one million records, but they would be automatically penalized for the 1% of records that were incorrect. In this scenario, are the penalties encouraging compliance, or are they simply a source of revenue for the state? A fairer system would acknowledge where compliance efforts are being made. Rather than penalize every payer for every error, use the penalties for those that fall below certain compliance thresholds (say, 80% or 90% compliance).

The laws themselves can be vague and open to interpretation, which leads to unnecessary litigation expenses. Terms such as “reasonable” and “usual and customary” are intentionally vague, and often states will not provide further definition of these terms.

How Can We Improve?

One of the goals of workers’ compensation regulations is to ensure that injured workers are paid benefits in a timely manner at the correct rate and that they have access to appropriate medical treatment. There was a time when payers had offices located in most states, with adjusters handling only that state. Now, with most payers utilizing multi-state adjusters, payers must be constantly training and educating their adjusters to ensure that they understand all of the nuisances of the different states that they handle.

The ability to give input to regulators is also invaluable, and payers should seek opportunities to engage with organizations to create positive change. Groups such as the International Association of Industrial Accident Boards and Commissions (IAIABC) and the Southern Association of Workers’ Compensation Administrators (SAWCA) provide the opportunity for workers’ compensation stakeholders to interact with regulators on important issues and also provides the opportunity to seek uniformity where it makes sense (EDI, for example).

There needs to be better transparency and communication between all parties in the rule-making process so that regulators have a better understanding of the impact these rules have on payers and the effort required to achieve compliance.

Developing standards in technology would be helpful for both the payers and the states. If your systems cannot effectively communicate with the other systems, you cannot be efficient. Upgrading technology across the industry, particularly on the regulatory side, has to become a priority.

Finally, we need to give any statutory reforms time to make an impact before changing them again because the constant change adds to confusion and drives costs. In the last 10 years, there have been more than 9,000 bills introduced in various jurisdictions related to workers’ compensation. Of those, about 1,000 have actually been turned into law. People expect that these reforms will produce the desired results immediately, when in reality these things often take time to reach their full impact.

These issues were discussed in depth during an “Out Front Ideas With Kimberly and Mark” webinar on Feb. 9, 2016. View the archived webinar at http://www.outfrontideas.com/archives/.