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Claims Professional or Archivist?

Balancing time constraints with documentation and core resolution functions.

December 18, 2015 Photo

Few topics are as likely to boil a claims professional’s blood as the subject of skimpy file notes. Auditors, home offices, bosses, and bad faith attorneys often pass judgment on documentation—or lack thereof—months or years after the claims professional has handled the claim. It seems like claims professionals never have enough documentation and often are criticized for inadequate claims file notes.

This is not surprising. A claims professional’s scarcest resource is time. In the hustle and bustle of frantic workdays, claims professionals must quickly decide how to use their time. They must make snap decisions, asking questions such as, “Do I investigate, evaluate, and negotiate claims in an attempt to close files or spend time documenting the file?”

Time is a fixed, finite resource. Claims professionals can use it to document or to perform core resolution functions. Clearly, there may be a happy medium. Life involves trade-offs, and these are part of the claims professional’s world; their workday is a zero-sum game. Time spent beautifying files for auditors, regulators, and supervisors may be totally defensible. However, that is time that claims professionals cannot use to investigate, evaluate, or negotiate claims.

What’s the Main Thing?

Claims professionals could excel in meticulously documenting what they have done, but if in the process they have little time in which to do, then what is the point? There is an apocryphal story about a British bus driver who was summoned by his higher-ups for blowing right past his designated stops, stranding waiting passengers. Called to task, he explained that, to have any chance of making his required time checkpoints, he could not afford to stop for passengers. Meeting the schedule became an end unto itself, with the main thing—transporting passengers—lost in the process.

For claims professionals, the main things are investigating, evaluating, and negotiating. Time spent on these tasks steals from whatever time is left for file documentation. If claims professionals spent as much time documenting files and updating progress notes as the “authorities” say they should, they would probably have scant minutes to investigate, evaluate, and negotiate. They might get high marks for file documentation but expose themselves to bad faith claims for inadequate investigation, shoddy evaluation, and failure to negotiate. There’s often insufficient time to do all these well, so claims professionals make quick decisions about prioritizing. What good is it to have a thoroughly documented claim file if, in so doing, claims professionals have less time to devote to their core job duties?

What’s Up, Doc?

When I see my family doctor, whom I like a lot, he enters the exam room and sits before a computer. Most times, his eyes are on the monitor as he enters data and notes into the computer. I’m not complaining. He does a good job of switching his attention between me and the computer. Still, due to charting imperatives, the doctor/patient exchange loses something. The documentation requirements, understandable in a medical malpractice context, have shifted physicians’ focus away from patients toward their charts.

After a shoulder injury from racquetball two years ago, I saw an orthopedist. His approach was different. When he stepped into the exam room, trailing him was a scribe. As he examined me and we talked, the scribe took notes in real time. This freed up the doctor to focus on patients.

Claims Professional Notes in Context

Often lost in discussion about claims professional file notes is that they are not transcripts. They’re not psychological journals containing a claims professional’s innermost thoughts; they are not diaries. Combined with other file documentation, though, a claims professional’s notes should enable somebody picking up the file to review it, see what has happened, and understand the general direction in which the case is headed. This direction may be settlement, defense, or further fact-finding.

Claims professionals often work in emergency room-type atmospheres where sensory overload is a daily risk. Phones ring, computer pings signal new email, and beeps serve as reminders. A red light flashes from the desk phone, reminding you of six voice mail messages. Somebody drops off a stack of papers to review. Two claims professionals are waiting to talk to you. And, by the way, you are late to the department meeting. “Stop the world—I want to get off. I must update my claim progress notes!” Sadly, the world doesn’t stop because a claims professional needs to update claim notes, nor is it realistic for them to do so. Claims professionals constantly grapple with cognitive overload. Are they claims professionals or archivists for future generations of claims auditors and bad faith lawyers?

Some will counter that it is not an either/or choice. It’s not a matter of either documenting or doing substantive claims handling; it’s a matter of balance. True, but if claims professionals in their limited time must make snap decisions, which task gets compromised? Is it documentation or claims handling? Which is more important—doing or documenting?

These are rhetorical questions, admittedly, but ones that highlight the challenge of meeting an exalted standard of claims professional file notation. This is not a manifesto for claims professionals throwing away claims progress notes or foregoing file documentation. Rather, this discussion places file documentation in proper context, weighing the risk of skimpy documentation versus the larger peril of neglecting the fundamental pillars of the claims professional’s job.   


Four Tips to Boost Claims Professional File Note Documentation

  1. Establish realistic caseloads. Overloaded claims professionals are reduced to fighting fires. With reasonable caseloads, they have more time to record their activities in the claims log.
  2. Provide periodic training on the importance of file documentation. This isn’t rocket science, but remind claims professionals how skimp documentation can be explosive rocket fuel to detonate their claims handling later in a bad faith case.
  3. View claims professional notes in the broader context of other file documentation. Like tiles in a mosaic, a claims professional’s notes are only part of the picture and a fraction of claims file documentation.
  4. Harness technology to boost file documentation and file notes. This includes voice recognition software and services where a claims professional can dial a phone number and dictate progress notes on a case or comments that enter the file with a date stamp—for example, SpeakWrite at speakwrite.com.
About The Authors
Kevin Quinley

Kevin Quinley, CPCU, AIC, ARM, is an advisor at CLM Advisors and is principal of Quinley Risk Associates, LLC. He has been a CLM Fellow since 2007 and can be reached at kevin.quinley@theclm.org, www.claimscoach.com.  

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