Non-insurance folks, especially those who aren’t happy with their insurance for whatever reason, or those seeking to write best-selling books (John Grisham, for one), use some pretty strong adjectives describing the heartless penny-pinching mean-spirited folk who are “the insurance company”.
While I don’t doubt that a few individuals and insurance companies really are cold-hearted emotionless drones, I’ve met very few that fit that description.
This was brought to mind recently while listening in on a meeting at an insurance company.
The occasion was a high-reserve claim review, attended by claims execs, adjusters, medical folk, and management, and the purpose was to review a set of very high-cost (over a million bucks in expected cost) claims.
The claimants were individuals who had, by and large, suffered horrible accidents at work – crushing injuries, burns, closed head trauma; really awful stuff. One claimant had suffered a devastating brain injury while “conveyor surfing”, a practice that involves trying to stand up on a conveyor belt high above a factory floor. The claimant fell on his head, causing severe brain damage, and has been hospitalized or in a skilled nursing facility ever since. The individual was a minor at the time, and the incident occurred many years ago.
The discussion around the table involved an opportunity to relocate the claimant from a relatively high-cost facility. Two options were presented, one of which would have involved constructing a house and hiring staff to care for the claimant. While the initial cost would have been high, the option would have saved money over the long term vs. keeping the claimant in a skilled nursing facility.
The other option was to move the claimant into a new residential facility located on the campus of a medical center. The cost was higher than either the present facility or the house. However, the claimant had been experiencing breathing problems of late, problems which had required transport to an emergency room.
The universal agreement around the table was to move the claimant to the new residential facility. Cost was discussed, but only in passing.
Few outside this room, or any of the other dozens of rooms holding similar meetings, will ever know about the goings-on around the table. In this case, the claimant, who has been non-responsive for over 20 years, is not capable of knowing.
But the people in the room knew what the right thing was, and they did it as a matter of course.
Insurance companies are people – mothers, fathers, sisters, aunts and uncles, daughters and sons and nieces and nephews. The vast majority care deeply about their families, their neighbors, their work, doing a good job, doing the right thing.
And I’d guess all of them saw the claimant as someone’s son, brother, cousin, or nephew, and made sure they did the right thing.
Thank you for this worthwhile post Joe. I comment on it at http://www.erisa-claims.com/blog/index.cfm?id=404.
Good post. As a 20-year insurance veteran myself, I hate to see so many smart, hard-working, basically good people who are trapped into making a tragically flawed system work. We know — better than almost anyone — just how futile and squalid the employer-based insurance system is, but this is what we know how to do. Furthermore, speaking for myself, I can remember a day when it didn’t seem like I was necessarily one of the bad guys. Misunderstood, possibly overenthusiastic, occasionally simply wrong, sure, but always trying to make something good happen for the greatest number of my fellow citizens.
Now, not so much.
Terrific reminder of the good things claims folks strive to do each day….and support for a system with unlimited medical lifetime liability that encourages long term responsible decision-making. Claimsfolks can do the right thing and mitigate long term costs at the same time.