Why Trust Is Essential to Workers’ Compensation Cost Containment
I was watching an old Western the other day, and there was this slicked-up guy in a suit, tie, straw hat selling an elixir that would cure nearly everything. This was the original basis for the “snake oil salesman.” Every salesman is selling a product that he believes is the best possible solution for whatever issues are present.
Every worker’s compensation vendor promises expertise, responsiveness, and superior outcomes. The difference between an average vendor and a trusted one is not marketing, it is consistency. Trust is one of the most powerful cost containment tools available to adjusters because trusted information leads to faster, more defensible claim decisions.
The undeniable truth is when trust is present, decisions are made faster and are clearly more defensible, supporting the need to ensure the injured employee gains all appropriate care. The contrary to this is that when trust is absent, everything is second-guessed. Trust is built through consistent performance, unfailing observable behavior, and demonstrated results. Trust is not a function of promises. Every day a claim remains unresolved due to uncertainty creates additional expense. Trusted vendor partners reduce uncertainty and allow adjusters to move files confidently and efficiently.
How Trusted Vendors Help Adjusters Make Faster Decisions
What does trust look like? In plain terms, reliability is at the forefront. Does that vendor do what they say they are going to do, meet all time limits, and price points so that there are no surprises. Are the determinations based on clear clinical alignment? Do the opinions match the identified mechanism of injury, the objectified clinical facts noted, and clear independent thought supported by the medical information provided?
The Importance of Clear, Evidence-Based Medical Reports
An additional consideration is that each report is easily readable. There are any number of terms that while technically correct can be overly confusing and these do not advance the case. Moreover, that hearing officer has to understand what is being stated and not be one who uses malapropism to impress. Or perhaps that clinician who uses obfuscation to elevate their clinical position. Neither assists in accomplishing the goals.
Lastly, there needs to be consistency in the determinations offered. The application of evidence-based medicine is clearly stated and contributes to a similar set of facts reaching the same clinical conclusion. Irrespective of whatever pressures are brought to bear.
The conclusions drawn should be solely a function of the clinical facts. The determinations should not be overly aggressive, and the reality is employees are injured and there will be pathology associated with the identified event. The author of these reports should not be passive or noncommittal. Straightforward, candid, with a clear establishment of the relationship between the pathology and the compensable event is the hallmark that needs to be provided.
Trust develops when there is clear support for the determinations offered, direction is provided, and the opinions are balanced. This is not an advocacy endeavor; this is establishment of the facts. There needs to be respect for the timeline as this can impact reserves, outcomes, and treatment. Each recommendation should be practical and clearly transparent. When the standards are provided, trust is earned.
Trusted Vendors Reduce Risk for Adjusters
The vendor/provider needs to maintain his understanding that adjusters are accountable for every aspect of the file. We vendors are part of that decision tree and strive to establish a relationship that is absolutely predictable and in no way demonstrates any risk. Trusted vendors reduce, and do not increase, the accountability burden placed on those claim file handlers. Delivering that document that can absolutely be trusted is the standard.
In a system driven by uncertainty, trustworthy decisions is the fuel that enable the vehicle to drive on. It has been my experience that no adjuster has ever stated “I wish this report was harder to use.” The best vendors are not those with the most credentials or the most aggressive opinions. Those elite vendors of those whose work product consistently allow claim file handlers to make the most accurate, timely, and easily defensible determinations. As I have come to learn, trust is earned one file at a time. Once established, it is one of the most valuable cost-containment tools available.
