“My challenge is dealing with the insurer; i.e. when their view point about an injured worker may not always be in line with view of the Rehab Return to Work Coordinator, employer and/or the worker themself.”
Dealing with the insurer’s claims’ manager is an everyday part of the job for return to work coordinators. Sometimes you’re on the same page with them, other times they seem to live in a different world.

Employers who have a clearly defined way of managing their cases often have the most difficulty understanding the insurer. The employer’s needs may not line up with the insurer’s needs; each has their own system and if their interests don’t intersect, problems occur.

Like most organisations you’ll find a variety of competences, approaches and attitudes amongst insurers. Some staff are on top of the cases while others won’t follow through on actions. A cooperative claims officer eases the situation, while one who doesn’t regularly follow through is a major impediment to your effective claims management. High staff turnover is another common problem.

If you are working under a large employer then you’ll have more clout than if you’re with a small employer. You might think that changing to a different insurer will help but often it doesn’t. However, there are things you can do to improve your relationship with the insurer you’re already working with.

If you want to have a good relationship there are some basic rules to follow. Not rocket science, just ongoing hard work—hard work that pays off with improved outcomes.

When you have a good relationship with your claims’ managers they are more likely to:

• Listen to your point of view;
• Return your calls;
• Adopt a cooperative approach; and
• Include you in their decision making process.

So how do you go about building this kind of relationship? Blitz these 8 tips!

1. Think about things from their perspective.

How much do you know about the working life of a claims officer? The case study below highlights some of the key issues they face...

“I am a well intentioned claims officer. I’ve been in my job for three years, and deal with a variety of claims, from the short and simple to the complex and going nowhere fast.

“I’m one of a team of six; we have a team leader and other support staff. Our performance targets are reviewed every six months and I generally struggle to make all of them.

“On my desk is my computer with a rather cumbersome case management system that links me with others in the team. I am managing 74 claims at the moment and the files of 12 of them are squashed to one side of my desk. Another six claim files are on the floor (one of the claim is up to three large folders). Some claims don’t require much time - with some cases I quite enjoy talking to the claimant, and there are others I just haven’t gotten to.

“I deal with 16 employers. Some are experienced and some have only dealt with a few cases. Some like to leave it to us, others like to be actively involved.

“One of the biggest difficulties I have is getting cooperation from employers; particularly the small employers. They often think the worker is not making enough effort. Some want cases investigated and rejected and they can get quite grumpy when we have to follow our own guidelines. I had one nasty employer but my team leader has taken over dealing with him.

“There is an endless maze of actions to complete, paperwork to be done and data to enter on the computer. We have performance targets to meet and I’ll often stay back an hour or two to get most of my outstanding work out of the way.

“Generally I cope with dealing with multiple activities, but I don’t deal well when people get angry. I try to be helpful but there are many things we have to do that leave people unhappy. People can become negative (both claimants and employers) and when that happens I find that gets me down. I’m not sure how long I’ll last in this job; I think it has a limited life span for someone like me.”

2. Get to know each other personally.

When relationships are stronger, you get a better read on the individual’s approach and it helps for ongoing communication.

3. Let the claims staff know how you want to approach cases.

They will usually respond favourably to whatever you can provide them. You should always avoid disputing a case, however if there are solid grounds for doing so, discuss it with the claims officer. Talk through the issues and you will be far more likely to work together constructively.        

4. Set up a regular type of communication.

A face-to-face meeting is more effective, although a telephone hook-up may be more efficient if you have time constraints. Ask the claims manager or claims team to meet with you at the workplace once a year - show them around, introduce them to your workplace, make them part of your team.

5. Put things in writing.

You might make a request by phone, but fire off a quick e-mail afterwards to confirm the agreement as well. Include timelines in your e-mail. The action is more likely to be completed and there’s documentation about the agreement if it isn’t. For example:

Thanks for the discussion. We agreed a medical review would be scheduled and the employee notified of the appointment by early next week.

6. Be positive in your dealings with the claims manager.

As we’ve just seen, they do a tough job and being grumpy won’t get you a better service. If you need something done, follow-up, and be polite and helpful. Put a smile in your voice but be clear about your needs.

7. Address persistent problems.

If you have a persistent procedural problem and things aren’t improving, arrange to meet with the claims manager and the team leader. Bring documentation of your concerns so the issues are clearly evident. Expect a clear outline of how your problems will be managed.

8. Solve challenges together.

If you have a ‘stuck’ case, arrange a meeting with the claimant and the claims manager. Work together as a group to find a positive way forward.

As we’ve seen from the Claim Officer’s reflections, many of them want to help – it’s up to you to foster the kind of relationship that will let that happen.