Insight, analysis & opinion from Joe Paduda


What comp payers care about

Over the last two weeks I’ve been talking with senior execs at many large and mid-sized work comp payers about claims management; their approach, focus, staffing, priorities, perspectives.

What’s been most enlightening was kind of subtle; it just sort of appeared after I reflected back on my notes from a couple dozen phone calls.

Sure I’ve learned a lot about different approaches, unique thinking, resources applied and the pluses and minuses of using internal staff versus vendors in various roles.  No one pretends to know it all, and many are very open to hearing opinions and views that conflict with theirs. Where there’s universal agreement, in fact the only place that exists, is the reason for what they do.

They all want the best care possible for the claimant, especially for those claimants that are grievously injured; burned, crushed, electrocuted, blinded; those with brain injuries and spinal cord damage and amputated limbs.  It’s all about getting the patient to the best possible facility as fast as possible, identifying and contacting the best possible physicians to oversee care, and making very sure the patient’s family is kept apprised and abreast.

At times there are problems, or screwups, or delays, and these execs are, to a person, angry and upset when their company somehow fails. They take responsibility, figure out what happened, and do their best to try to prevent a future mistake. They do this because they really care about what they do and take their commitment to their policyholders and their employees very, very seriously.

I am absolutely sure there are execs at work comp payers who don’t think this way, who see their job as a job, claimants as problems, and are not terribly concerned about the wellbeing of those claimants.

I am also very sure this latter group is a minority in the work comp industry.  One of the exec’s comments capsulized what others were saying in different words; “we want to send the patient to the same provider we’d want our kids to go to if they were in this situation.”

And they do.

What does this mean for you?

The work comp industry has a lot of warts, but there are also a lot of really good people who strive every day to do the right thing.

6 thoughts on “What comp payers care about”

  1. Hear, hear! I’m proud to work in an industry full of people who truly care and work hard to help others….and Joe, that’s what our business and the vast majority of the people in our industry, are truly all about!

  2. The overall approach sounds fine and groovy. Then you get a claim where Claimant worked two-and-one-half days for my client, didn’t suffer any injury we are aware of and then ran up $17,000 in disputed bills.

    My clients and I don’t want this person to treat at all so the “best possible care” model doesn’t work in such claims.

  3. I agree, but I’d like to see some WC people listen to me for a change…that would go a long way to prove that they really do want to hear the opinions and views of others.

  4. I agree Joe. Almost everyone I have talked to in the industry has a story about a claimant that they really helped. But sometimes it is very hard for people to see and understand what a wise decision should be. Is back surgery the right thing given its risks?

  5. If it’s all about getting patients the best care possible then why are so many patients steered away from high-quality providers to the cheapest providers by management provider networks?

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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