Simple Concepts for a Complex System – Reminders for a Claims Office

When managing claims operations. It is good to send out regular "reminders" to the claims staff.  Here is a starter list.  Some of these are intended for supervisors and managers.  Most are for the entire staff.  Not all are entirely focused on claims issues but are general reminders that promote productivity through better quality of life.  Many of these items may involve human resources and the company’s internal policies and procedures.  I recommend that you develop your own reminders based on your own culture and philosophy.  There should be enough “reminders” in your portfolio to provide regularly scheduled weekly reminders with just a few reminders per email.

January

Cyber Security.. Change the passwords regularly. Remind the staff not to respond to any phishing emails or any emails asking for direct payments or any emails from unknown sources (Emails from Nigeria asking for banking accounts are good examples). 

Establish and communicate the claims goals for the year.  Everyone in the office (clerk all the way to the manager) should know the goals.

This is the best time to develop your division’s game plan to meet the goals; they don’t just happen.

The office (and even claims units) results should be posted every month.  Claims goals should include closure ratio, reopening ratio, timeliness of benefit determination (accept/deny) shelf life, subrogation recovery. 

It’s time to run your year-end reports and analyze last year’s results.

Set a regular time each month to celebrate birthdays.  Send a birthday note to the employee on the special day.   Celebrate with a cake, ice cream, pie, or other food which is appropriate for the company culture and employee.

Update your claims manuals and internal policies. (Make sure the staff is trained on any changes)

Make sure the performance reviews are complete and on time. (In some offices, the annual reviews are all done together at the first of the year.  Some companies review their employees annually from the individual’s start date).

Supervisors should keep current with the monthly Self Audits. 

Be aware of questionable claims that may come from attempts to work off the extra pounds that were gained over the holidays

Be aware of the need for changes in the temporary disability benefits in the claims where there may be an annual scheduled increase in the maximum rate.

Send out thank-you notes.  This is a common courtesy that has fallen into disrepair.  A personal thank you note to an attorney or other vendor for outstanding effort, service or results can be very effective in producing increased results, productivity and loyalty. And it is the right thing to do.

When is the annual data pull for the actuaries?  Reminders should go out to close as many files as possible the month prior to the data pull.

An excellent month to remind and retrain the staff on adherence to the company privacy policies.

Common colds and flu are spread through coughing and touching infected objects such as door handles etc.  Simple hand washing and covering the mouth reduce the overall number of colds and flu (and increase presenteeism at work). This was originally written to the Covid-pandemic.  The importance of handwashing and social distancing has increased in the last few years.

Remind everyone to stay home if they are not feeling well. It does no one any good for a “hero” to fight through a cold or flu to bring it to the rest of the staff.

January is also the month that many companies schedule their internal privacy and security training programs.  Check with HR and make sure that the internal compliance programs are on the schedule.

February

Claims roundtable schedules should be set and a list of cases developed.

President's day weekend and "ski" week are a great time for subrosa.

Cut back your roses after President’s day. 

Employers are required to post the OSHA results for the prior year.  Are your customers in compliance?  Sometimes some dates for the OSHA report are produced by the claims administrator.  

Make sure that the office is complying with the laws concerning the posting of its own OSHA report.

Flossing is not only good for dental health, but it also promotes good breath and is heart-healthy. (Because of Valentines Day, February is designated as the month for heart awareness by the American Heart Association)

March

St Patrick's Day is a good day for subrosa in certain parts of the U.S.  

Change the clocks and check the smoke alarm battery on daylight savings time.  The annual “Spring Forward” usually results in increased incident of heart attacks. Remind the employees to be aware of their sleep patterns and not to let the time change impact them.

A good month to have attorneys come in and provide an update on the trends that they are seeing from the latest changes in case law and how to minimize the damage or maximize the results.   

An excellent time to update the law firms on corporate claims handling protocols, their settlement authority, and vendor management. 

April

Prepare for an increase in casualty claims as the weather improves. 

Focus on your high dollar and aged inventory close as many as you can by the end of August. (usually, the first preliminary data pull for actuaries).

State and local jurisdictions may have claims examiner training requirements.  This is a good month to ensure compliance.

For some claimants reminding them of the approaching Tax day is a good negotiating tactic for achieving a settlement.

Easter weekend is a great time for subrosa.

May

Summer vacations are pending.  Now is the time to get all of the summer vacations scheduled to ensure the happiness of employees and coverage of the claims units.  I always liked the concept that vacations were scheduled based on seniority with the company, not based on position.  Usually, it was a claims assistant or clerk who got to go first.

The Memorial Day weekend (three days) at the end of May is a great time for subrosa (if you are going to do subrosa on a three-day weekend, don't limit it to just one day or only a few hours but do it right).   Subrosa prep should include a review of ISO and any public internet sites such as tic toc, Facebook, etc. for possible “chatter” on upcoming events.

June

Increased vacations can result in reduced claims frequency. 

Usually, the kids get off mid-June which creates problems with increased demands on parents who have school-age children who are now at home.  Supervisors usually know who is at risk for increased time off to deal with "summer" emergencies.  If the supervisors are aware of such issues and work with the employees to deal with such issues, it promotes better presenteeism and a more productive employee.

FLAG  DAY June 14.

July

The fourth of July is a great weekend for subrosa.

July is National Baked Beans Month.  Michigan leads the nation in the production of dry edible navy, black, & cranberry beans.

Halfway through the year, review goals, strategize on goals. 

August

Actuaries run loss history, did your efforts to close high dollar and targeted inventory pay off?

August is now the time for the first day of school.  Front line supervisors and managers should encourage their employees, who have children who are going into kindergarten or the first grade, to make sure that the parents spend the extra time to visit the classroom and meet the other parents in the school.  (If the parent knows the child is safe and happy then the parent is more productive at work) let your employees know that you do not expect the employee to be at work by nine on the first day of school.

National Immunization Awareness Month:  Each year, this commemorative month increases awareness about immunization across the lifespan as parents and children prepare for the return to school, and the medical community begins preparation for the upcoming flu season.

September

September is usually the month of the year with the highest frequency of claims.  Prepare the office for the additional workload.

Every employer has its own claims frequency trend.  Most insurance companies see an uptick in claims frequency in September when the vacations are over and everyone is back at work.

Labor Day weekend is a great time for subrosa.

Back to school night is usually in Sept.  Expect parents of school-age children to get off early to be able to make it to the school on time.

Birthdays are a great time to set resolutions to stop smoking.  Sept and October are the months of the year with the greatest number of birthdays.

October

The safety of our employees is important.  As the days become shorter it is important for those who are commuting on public transportation, to be aware of their surroundings.  Have your keys ready and be prepared to quickly get into your car.  Look for suspicious people who are likely to create mischief.

As the weather changes so do the nature and types of slips and falls. 

Halloween is a great time for letting the creative side of the office show itself.  Prizes for costumes and for office decorations (fire safe) are always well received.

Flu season is approaching.  Encourage flu shots for those who believe in preventative measures.

In certain jurisdictions, the first day of hunting season is great for subrosa.

Never park your car over a pile of leaves! The muffler and catalytic converter on cars get extremely hot and can ignite the leaves under your car - causing your car to catch fire!

November

When claims are on the decline, focus again on closing out those cases that can be closed.  Christmas is rapidly approaching. Some claimants and applicant attorneys will want additional revenue.  

Daylight savings time again.  Check the clocks and the fire alarms.

Thanksgiving weekend subrosa can be problematic because most folks are in their homes or are in the car.

The first serious snowfall is usually an excellent opportunity for subrosa.

December

Drunk and Drugged Driving Prevention Month. 

Have vendors submit any outstanding invoices early so they can be fully paid by the end of the year. 

Remind the examiners of the importance of compliance with the company gift policies.  

Inform the claims systems administration staff of any need to change the standard rates for TD, PD, or death benefits that will be effective on January 1 of next year. 

The week between Christmas and NewYear is usually fairly quiet.  It is an excellent time for the examiners to clean out their desks, remove old forms and paperwork as well as update contact lists, back up their data, etc.

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William M "Bill" Zachry is a Board member of the California State Compensation Insurance Fund, Appointed by Governors Arnold Schwarzenegger and Jerry Brown. He served 3 years as a Senior Fellow at the Sedgwick Institute. His term ended in January 2020. Zachry was awarded the Summa CompLaude award in November of 2020, the RIMS Risk Manager of the Year 2014, the CCWC Workers Compensation Professional of the Year 2016, Co-Chair AMICUS Committee California Chamber of Commerce. He is the former GVP Risk management Safeway /Albertson's Former Board Member California Self Insurers' Security Fund, former Co-Chair California Chamber of Commerce AMICUS committee Chair California Fraud Assessment Commission Zenith Insurance Company VP Claims HIH (C.E.Heath) (Care America) S.V.P. Claims. References

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