Tag Archives: interpreter

Are You Tapping Your Innovation Energy?

The insurance industry is facing seismic and unprecedented shifts on multiple dimensions. From increasing client expectations to new emerging risks, from the emergence of robo-underwriters to the ever-present question regarding the role of traditional channels, insurance carriers have multiple fronts on which to re-think, re-look and address innovation challenges and opportunities.

The culture of the insurance sector is changing. The momentum to engage, identify new frontiers of competitive differentiation and execute outcomes has clearly started. As a case in point, Insuretech Connect, the largest insurtech conference had 1,200 participants in 2016, 3,800 in October 2017 and 6,000-plus this year. At events like this, you can feel the incredible energy of insurance professionals, regulators and startups.

Insurance organizations are full of insurance professionals with incredible skills and commitment to always go the extra mile. Driven by an entrepreneurial spirit, they seek to reinvent the way things are done and have in many cases always been done. A few trailblazers have challenged their organization’s formal rules and forced habits and have pushed bottom-up innovations within their organizations. Yet other committed insurance folks have been involved in top-down programs that have been created by their companies to capture and execute the next frontier of innovation.

We find that, unfortunately, large segments of the workforce do not engage with the innovation process of their employer. We often find that some of the best concepts, opportunities and solutions find the exit sign faster than they find traction within the boundaries of their firm. In some cases, people push for their innovations as side agendas, often driving them as secret agendas where their energies and attention are spent. In other cases, people simply decide that it’s better to pursue the art of the possible outside of the firm.

We believe that this is a pity and a waste of positive energies for the existing incumbents. Carriers should embark on building a foundation that creates the conditions and enables mechanisms for promoting the culture of innovation and channeling this energy in a productive direction for the company.

We have worked in and with large and international organizations and know well how these complex elephants live and how difficult it is to set formal processes able to promote virtuous circles and orchestrate innovation as a “living, breathing and relevant” process. This issue is big and complex, and there is no magic wand to solve it.

We would like to start a discussion on how this issue can be addressed in the insurance sector. The problem as mentioned has many different angles. We decided to start by addressing one aspect of the current state—the silos. Traditional silos are one of the of the killers of insurance innovation.

We recently came across situations that speak volumes to the need to consider foundational investment in integration capabilities. We present three myths that often prevent even forward-looking carriers from pursuing well-intentioned innovation strategies. Getting underwriters, risk engineers, marketers, product developers, actuaries, claim handlers and technology folks to break out of traditional silos will need to be a critical first step before any innovation investment or program is considered.

See also: How to Get Fit for Innovation  

The Myth of the Innovation Mirror

A top performer in a line of business at a well-recognized carrier was promoted and placed in the company’s innovation group. This leader was a recognized expert in his functional domain and was often sought out for insights on both legacy issues and emerging trends. During a recent meeting, we asked him for his opinions on the issues being faced by a key stakeholder and partner group within the same firm on a business line that, while different, was really close to his business line.

Much to our surprise, this leader said, “I have never thought of their business line. I don’t know.” We left the meeting with a surprising realization that there are probably many other top performers who excel in their chosen disciplines within well-defined boundaries, yet do not seek to expand the vistas of their exposure or to apply their knowledge to related domains. Their organizations have correctly encouraged their growth and specialization in one domain but have probably never facilitated exchanges between business lines or forced them to go out they comfort zone. We call this the “Myth of the Innovation Mirror,” where the images we focus on are constrained by one’s own areas of expertise.

The Myth of the Signal Catcher

A leading U.S. carrier saw the departure of one of its top line leaders. This individual had spent decades building a robust P&L, operating team and client relationships. He had been recognized for his thought leadership and for building teams that pushed the boundaries of what’s feasible and valuable for their clients, but he was not directly involved in the innovation program of the company.

This company boasted of a well-funded and successful enterprise-wide innovation program, championed by the CEO and supported by divisional leaders.

The irony of this departure was that the executive left to pursue an independent entrepreneurial venture because he believed that his ideas and the innovative value proposition would not be implemented by the firm. Despite having a robust and well-managed innovation program, the firm failed to catch the signal that one of their very own was both willing and able and highly motivated to create a future-forward product today.

There could be many reasons for this specific departure but we believe that it probably happened because this leader was not formally affiliated with the innovation program. There was no mechanism to watch, catch and act on the weak signals that this leader was sending out, weeks and months ahead of his departure.

We believe that this myth of the signal catcher is a serious risk that carriers have to consider and address. Simply creating and operating an innovation program is not adequate and sufficient. Creating the ability and the mechanics to watch, interpret and catch the weak signals coming out of individual and or team efforts is as important if not more important than simply being a scouter of startups, or an inventor of ideas and concepts or an evangelist of the innovations.

The Myth of Action

Finally, we address the “Myth of Action.” A global insurance carrier has innovation centers across key markets. A formalized program exists where leaders and staff resources spend dedicated time getting together and converting their individual ideas and interests to collective outcomes. Some of these centers represent centers of excellence in different domains.

In this scenario, we found that an innovation team in one part of the world—while working on a new topic for them—was almost devoid of access to similar concepts and work that had already been pursued halfway around the world.

As carriers with a global footprint address innovation outcomes, it will be critical to ensure that action is not mistaken for outcomes. Bridging the distance within and between different centers of innovation is crucial to ensure that the teams do not end up becoming innovation silos unto themselves.

The “Myth of Action” arises when innovation champions or leaders assume that presence and permanence are sufficient. We are perfectly aware of the local specificities that make the possibility of simply copying-and-pasting an insurance solution coming from another country a utopian idea. But many ideas can inspire location-specific variations and be tailored to the local needs. While presence across regions and permanence from a mandate perspective are key, we believe that it is more critical to ensure that physically far-removed teams get structured and unstructured opportunities to be exposed to work that peer groups are driving at non-local locations. Researchers have found that proximity is a key driver of organizational effectiveness. Solving for this “distance bridging” will be critical. Simple tactics like designing intentional cross-location collaboration will ensure that exchange of ideas in large and complex organizations can transcend distances.

So how can you attack these myths head on and build or mature your innovation practice?

We recommend that innovation efforts identify three distinct but connected archetypes for roles/resources working with an innovation focus. We propose the trifecta of Observer, Interpreter and Storyteller. Think of these as hats or lenses, rather than roles or restrictions.

Observers are designated to be non-judgmental observers of actions, outcomes and opportunities. With two leading questions of “What do I see?” and “Where do I see?”, Observers play a key role in taking a non-action view and in scouting even where you don’t expect to find anything.

Interpreters are driven by two different questions. While the Observer has simply made her observations known, the Interpreter asks, “Why do I see what I see?” and “What does this mean?” These questions are designed to help the Observers dive deeper into the observations they are presented with, but also to rationalize the knowledge and ideas identified. While there might be a temptation to go broad and expand the scope of one’s assessment, we believe that focusing on depth and asking increasingly fine-grained questions is more beneficial.

Storytellers are the final actors in an innovation practice. We humans are wired for storytelling. From time immemorial, our ancestors have passed on down through generations many a story of heroes, victors and vanquished. We recommend that the Storytellers play their part in the modern version of “tell me a story,” and spread the word about the insights that the Interpreters have distilled. The storytellers have to evangelize, inspire and motivate the organization in the adoption of innovation.

See also: Key Trends in Innovation (Part 6)  

Taken together, the Observer, Interpreter and Storyteller create the much needed and often missing enterprise-scale integration that helps make innovation efforts successful. These archetypes can be introduced and embedded into almost any current innovation program. Their integrated activities will contribute to channel the positive energy in a productive direction for your company.

Think of these as calibrations you can do to any currently defined innovation operation, resource or delivery model. Done right and executed consistently, these three roles can help address the three myths, and the risk of innovation teams not living up to the promise of what they can truly deliver.

In many ways, the IoT Insurance Observatory (spearheaded by one of the authors of this article) has applied this trifecta of lenses with an extremely narrow scope—the usage of sensors within the insurance sector—targeted at the open market (opposite to the internal focus of the discussion above). This think tank is, first of all, constantly observing and scouting the usage of sensors in different insurance business lines around the globe. Second, it is interpreting best practices and pitfalls for the members, so providing them the most globally relevant IoT insurance knowledge. Last but not least, it has as a core deliverable the storytelling of this knowledge through workshops dedicated one-to-one to each of the organizations that are members. In this way, the Observatory has aggregated almost 50 organizations between North America and Europe and is promoting IoT adoption in the insurance sector.

We believe carriers can employ these three tactics/rules to mitigate the risks of the three myths. These tactics are part of the solution for the big and complex problem of how to promote virtuous circles and orchestrate innovation.

Join our discussion to find additional solutions to catalyze all the positive innovation energy is emerging in the insurance sector.

The article was written by Matteo Carbone and Sri Nagarajan.

Effectively Defending Against Interpreting Liens

Liens are a huge problem in California. Division of Workers Compensation Adminstrative Director Rosa Moran has recently stated that lien issues threaten the entire workers’ compensation system.1 Much of the focus is directed towards various areas of medical liens.

Interpreting liens are often overlooked as the actual dollar amount requested is typically much lower than medical liens. However, this doesn’t mean that you should be paying interpreting liens that aren’t legally owed simply to close a file.

You might be surprised to find out that much of the time you are probably paying interpreting fees that you don’t have to. In fact, on March 17, 2011 The Workers’ Compensation Appeals Board issued an en banc decision detailing exactly what is required of interpreters in order to prove that they are entitled to their fees in the case of Jose Guitron v. Santa Fe Extruders 76 Cal. Comp. Cases 228. This is the case that interpreters don’t want you to know about, because it is extremely difficult for interpreters to meet the legal requirements to obtain their fees.

When Are You Required To Pay Interpreter Fees?
The rules for when qualified interpreters are specifically required can be found under 8 CCR §9795.3. Generally speaking, interpreters are required for examinations by physicians at the request of the claims administrator, the administrative director or the appeals board, med-legal evaluations, depositions, hearings, conferences, arbitration and other settings determined by the Workers’ Compensation Appeals Board to be reasonable and necessary to determine the validity and extent of injury to an employee. Additionally, Guitron provides that pursuant to the employer’s obligation under LC §4600 to provide medical treatment to the injured worker, interpreters must be provided to workers at medical examinations if the injured worker cannot speak, understand, or communicate in English.

What Are The Legal Requirements On The Interpreter To Recover Fees?
The interpreter has the legal burden of proof to show that the services provided:

  1. were reasonably required,
  2. were actually provided,
  3. were provided by someone qualified to do so, and
  4. were reasonably charged.

1. Services Were Reasonably Required
The injured worker will need an interpreter if he or she does “not proficiently speak or understand the English language.” (AD Rule 9795.3(a)) There are a number of ways this can be demonstrated. Interpreter use during a deposition can prove a need for an interpreter during medical and legal proceedings. A physician statement that an interpreter was required during a medical exam, an interpreter’s testimony or sworn statement that he or she confirmed with the physician or the attorney’s office that an interpreter was needed, or a worker’s testimony that an interpreter was needed can all prove that an interpreter was reasonably necessary. If the defendant has authorized interpreting services, the interpreter will not have to prove that interpreter services were required for every date of service.

2. Services Were Actually Provided
The interpreter must also prove that he or she was actually present on the date of service in question, and that services were actually rendered. Some ways that this can be shown include the deposition transcripts, or in the case of a medical examination, the doctor noting that the interpreter was present in the report. The interpreter can also have a medical examiner or the applicant sign a form that states that the named interpreter was present, and that an interpreter was actually needed. In the case of doctor’s evaluations, the form should also include that the doctor doesn’t speak the patient’s language, the doctor doesn’t provide interpreters, and that the office’s policy is that patients who are not proficient in English should be accompanied by an interpreter. There are of course other ways for an interpreter to prove that they were present. However, the interpreter must prove that they were present if you are going to pay for the bill. The burden is on the interpreter to prove this. It is almost always a good idea to also cross reference the medical report with the actual bill to verify that the interpreter named is the same on both documents.

3. Services Were Provided By Someone Qualified To Do So
The interpreter must be qualified to provide the billed services. Remember to always request information regarding an interpreter’s certification. Very often interpreters used are not legally certified. A qualified interpreter is a “certified” or “provisionally certified” interpreter pursuant to 8 CCR §9795.1(f). When the setting is not an appeals board hearing, arbitration or formal rehabilitation conference, and when a certified interpreter cannot be present, a “provisionally certified” interpreter may be used.

Provisionally certified interpreters are deemed to be certified by agreement of both parties (8 CCR 9795.1(e)). Often interpreters will claim they have been provisionally certified, but if you didn’t agree to the interpreters qualifications and they aren’t certified you probably don’t have to pay. However, be careful as Government Code Section 11435.55 provides that in medical examinations, if a certified interpreter cannot be present at a medical evaluation, “the physician provisionally may use another interpreter if that fact is noted in the record of the medical evaluation.” ‘Even though an interpreter must be certified for medical legal charges such as depositions and Workers’ Compensation Appeals Board proceedings, an interpreter still must prove competence to provide these services. Simply claiming to be qualified is not sufficient. Items to request include training, education and the nature (type) of interpreting services provided.’

4. The Interpreter Must Show The Reasonableness Of Charges
Remember that the interpreter must prove that the charges are reasonable. You can look to 8CCR §9795.3(b)(2) for a fee schedule on interpreting fees. In most situations, the fee schedule will be $11.25 per quarter hour or portion thereof, with a two hour minimum, or the market rate, whichever is greater. The interpreter can establish the market rate for fee fees by submitting documentation to the claims administrator, including a list of recent similar services performed and the amounts paid for those services. Market rate is defined as “that amount an interpreter has actually been paid for recent interpreter services provided in connection with the preparation and resolution of an employee’s claim.”(8 CCR §9795.1(h)) Always argue that the market rate is fee schedule in the absence of any evidence to the contrary.

The fee schedule does not apply to regular medical treatment. In cases of interpreting liens for medical treatment, the court relies on the factors enumerated in Kunz v. Patterson Floor Coverings, Inc.(67 Cal. Comp. Cases 1588). The court will consider: a) the usual fee accepted (not charged) by the interpreter, b) the usual fee accepted by other interpreters in the same geographical area, 3) other aspects of the provider’s practice that are relevant, and d) any unusual circumstances in the case. Once again, you can always argue that $11.25 per quarter hour is reasonable, and the two hour minimum may not apply. The interpreter could conceivably have only been at the doctor’s office for 15 minutes.

“Market rate studies that only site State Fund are insufficient. They should include payments from several carriers and for what types of services. Also, your attorney & need rebuttal evidence to market rate studies and they should include payments made to several interpreters if your case will be set for trial.”

In denied cases settled by Compromise & Release, the interpreter must prove AOE/COE issues to recover fees for non med-legal medical interpreting.

Just like with any other medical lien claimant, when a case has been settled by Compromise & Release and liability has been denied, the lien claimant must show that the injury arose out of and occurred in the course of employment, and that the medical treatment itself was reasonable and necessary. This is important to remember, as many disputed interpreter liens have to do with lien treatment by doctors. The burden is on the interpreter to prove AOE/COE issues and reasonableness of treatment in order to recover fees.

Remember that all of the above must be proven by the interpreter to recover fees. This is a relatively high burden of proof on the lien claimant, so make sure to demand all proper documentation before you pay interpreting fees. If they can’t provide all of the necessary documentation, you shouldn’t be paying.

1 “Moran Says Lien Problem Threatens Entire System” Greg Jones. Workcompcentral.com, 01/24/2012