Without proper communication in the claims process, innovation has limited utility

It struck me during a recent conversation with a long-time colleague in the risk claims domain, that the drive for innovation in the disability claims arena may have seduced insurers into believing that innovation is the answer to all of the challenges experienced in the environment. This is a belief that years of professional experience in assessing lives assured and high court claimants who have suffered illness and injury has proven to largely be false.

While it is common cause that one must move with the times and it is prudent to ensure that robust data capture; analytics; financial management and claims processes are in place in order to minimise error and optimise efficiencies, there is a limit to how much one can innovate and systemise the human aspect of claims management. To some extent it may be experienced by the recipient as an insult to even try.

One cannot innovate around the art of communication when it comes to dealing with the human-ness of disability and injury claims matters. What is required is the skill of listening; expert assessing; correct reading and application of factual evidence and contractual terminology – and appropriate communication throughout the relevant phase of assessment or on-going management of the matter in hand.

The best investment one can make in oneself and in the team of personnel tasked with assessing and managing the claims of those who have suffered illness, injury and functional loss is that of investing in expert knowledge, upskilling and training across all areas, with communication skills being a priority.

All too often the complaint at the commencement of an assessment, irrespective of whether it be in the form of an evaluation of the individual or of the papers relating to a claims dispute, is that there has been some kind of breakdown in understanding and communication between the parties. This extends from doctor’s ‘not listening’ through to claims assessors and managers being experienced as having seemingly ‘ignored’ the unique aspects of the person’s life.

Who is ‘right’ and who is ‘wrong’ is not the issue here – it is how the individual concerned has experienced the process.

Therein lies the root of many an unpleasant relationship; of the desire to ‘take things further’; of the ultimate involvement of the Ombudsman for Long Term Insurance and or the threat and commencement of litigation.

No amount of innovation – no matter how brilliant – can replace the solid foundation required in understanding the legal boundaries of contract; appreciating how the medical, functional and occupational evidence stacks up within such boundaries and the appropriate communication thereof.

And no amount of innovation will ever replace the need for the human touch of listening, understanding and appreciating the circumstances that have temporarily or permanently stripped an individual of their functionality, independence, capability and sense of human dignity.

When one ensures a smooth, mutually helpful process in which all players feel recognised, heard and are satisfied with the manner in which the claim is handled, one is able to by-pass the need for the negative consequences alluded to above.

The most important investment any insurer, expert and professional can make is that of arming themselves with sufficient knowledge and capability to listen on all levels, so as to reasonably weigh up and balance the facts with which they are presented in order to ensure a fair and just outcome, as well as a smooth claims process.

The most powerful tool in respecting and honouring our human-ness is that of making use of our very same human-ness. There is no short cut.

EBH
March 2018