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RISK MANAGERS NOT THE ONLY CUSTOMERS

Posted On: Mar. 9, 1997 12:00 AM CST

WHO IS THE CUSTOMER?

This is a question I recently posed to a group of risk managers and insurance/finance professionals.

They were attending a Risk & Insurance Management Society Inc.-sponsored course in San Diego on workers compensation management. The group was varied and represented diverse industries. Their experience level ranged from considerable to new in the industry.

On the first day of the class, I asked them who they thought their customer was. We were discussing benchmarking and how to arrive at objective performance indicators. To decide which performance indicators to use, you must first decide who your customer is and how that customer will perceive value for the services you offer. They agreed with the "value-added" equation, but there was some active discussion about the definition of the customer. The final answer was nearly unanimous. From a third-party administrator's perspective, they thought the customer was the risk manager, and secondarily-though just as importantly-the local plant manager or local contact for the TPA.

They did not think the employee or injured worker was a customer, and their reasoning was as follows: The risk manager's work in putting together a viable program benefits the employee. Injured workers have no choice but to participate in the program as selected by the risk manager and, therefore, they cannot be considered a customer, as they aren't a buyer.

Frankly, I was surprised and disappointed by this answer. I had been giving it a lot of thought over the past few months and had come to the conclusion that the employee is indeed a customer. In fact, the employee may be more important in terms of outcomes than the risk manager.

Certainly, as the decisionmaker, the risk manager is a primary customer, but he or she cannot be involved in every aspect of the program on a day-to-day basis, and, in fact, may have very little contact with the TPA except on large or catastrophic losses.

On a very large program, it is difficult-perhaps even impossible-for the risk manager to get to know every adjuster, claims specialist, nurse or vocational consultant who may be involved with claims administration. The risk manager is a customer from a purchasing standpoint, but not from point of service.

You may argue that plant managers or the local contact for the TPA are the point-of-service customers.

But are they really? Do they get involved in every claim? I would guess not. After all, they already have jobs to do, and coordination with the TPA is only one small part of that job. They are involved in reporting new cases, coordinating return-to-work programs with the adjusters and consultants and answering questions should an injured worker call with a query or problem. Because most workers comp claims are handled entirely by the TPA, contact on non-problematic cases can be quite minimal. I'd venture to say the local plant manager would prefer not to get involved in the claim process and is content to leave claims activity to the professionals whenever possible.

So, who is the customer? Who but the injured worker sees every aspect of the claim process? Who but the injured worker knows if actions and tasks are carried out on a timely basis? Who but the injured worker knows if the adjuster treats him or her with respect, empathy and with a goal to return to work? Who but the injured worker knows if the nurse coordinates medical treatment for quick healing, questions the doctors as to treatment methods and provides the doctors with accurate work requirements? Isn't the injured employee, then, the true point-of-service customer?

In fact, this is the conclusion the RIMS group drew the next day. We had had discussions about return-to-work programs, Americans with Disabilities Act issues, managed care and the claims administration process during the course of that day and the morning of the next. The discussion included everyone's "secret" for managing outcomes.

These secrets included:

Supervisor involvement is important to make injured workers feel like they're part of the work team.

Injured workers need to know that the objective is to return them to work as soon as possible.

Reported injuries increase at plants that have morale problems.

The adjuster/nurse/vocational consultant need to establish a relationship of trust with the claimant.

The adversarial relationship must be defused to have the best outcomes.

Attorney involvement is reduced if employees feel they are being treated fairly.

The best people to ask about workplace modifications that may be necessary are the workers themselves.

After listening to these comments, and after only one "I told you so" from me, the opinion of the group changed.

Give this some thought. To maximize the outcomes of the program you have instituted, consider the customer you serve.ministration process during the course of that day and the morning of the next. The discussion included everyone's "secret" for managing outcomes.

These secrets included:

Supervisor involvement is important to make injured workers feel like they're part of the work team.

Injured workers need to know that the objective is to return them to work as soon as possible.

Reported injuries increase at plants that have morale problems.

The adjuster/nurse/vocational consultant need to establish a relationship of trust with the claimant.

The adversarial relationship must be defused to have the best outcomes.

Attorney involvement is reduced if employees feel they are being treated fairly.

The best people to ask about workplace modifications that may be necessary are the workers themselves.

After listening to these comments, and after only one "I told you so" from me, the opinion of the group changed.

Give this some thought. To maximize the outcomes of the program you have instituted, consider the customer you serve.

Elise Farnham is assistant vp for Crawford & Co. and assists in the creation of new initiatives with its business process management group. She is vp of the National Assn. of Insurance Women.