California (hard to even type without sounding like the Governator) came down hard on Cigna for “Irregular Claims-Handling Practices” in how the company was dealing with Long-Term Disability Claims. Cigna will also pay $77 Million to affected policy holders, Business Insurance magazine reported this week.
To a company as big as Cigna (over $20 Billion in Revenues in 2011) this is probably just one day’s order of paperclips, but it sends a message to everyone processing claims- You need to be consistant or you will pay.
We’ve seen this time and again in the workers’ comp world. Companies get a hauled to court for not operating consistently whether its relatedness decisions or paying providers. This puts a lot of pressure on the adjusters to look beyond the specific claim. How one would handle this claim can impact how the entire company should handle a claim.
It’s an unfair battle to pit individual adjusters against the world and expect them to operate consistently, especially while under different jurisdictional time constraints. Just wait until ICD-10 hits and watch this kind of trouble multiply.
Adjusters need to be able to spend time adjusting, and lean on technology to make their lives easier and ensure that their actions are in line with the organization’s guidelines. Then maybe adjusters can help get workers back to work and out of the doctor’s offices.
I’ll offer this disclaimer, our company, Acrometis, makes a cloud-based product, CLAIMExpert, that helps adjusters do just that. It works with Claims administration systems to do the nitty-gritty work associated with processing everything associated with Claims. 10,000 plus rules handle all the claims related materials (bills, attorney correspondence, doc notes, etc), handling 75% of adjusters’ tasks and freeing up 40% of the adjusters day. More importantly for this article, claims are processed consistently. Decide to recode one bill from a doc to a more realistic fee, and all bills get recoded consistently. All with an audit trail that keeps the auditors happy.
So, when I see stuff like this happen, I know it can be avoided. Add to this that CLAIMExpert requires no upfront cash, little IT resources and can be implemented in a quarter, and you can see why I pull out my soapbox every time I hear about something like this.