Cultural Competence and the Diversifying Workforce

As our nation’s population continues to diversify across racial, cultural, and ethnic backgrounds, so does our labor workforce. However, the rate at which the country’s labor force continues to diversify is not equally mirrored in our claims professionals and administrators. Until the claims professional demographic catches up, understanding unconscious bias and being culturally competent can be essential in reducing claims costs overall.

We are all as unique as our own individual backgrounds and experiences, which are a composite made up of many variables. If you were to ask, “What makes me who I am?” you would say more than just your gender or race. Our social identity comprises a multitude of parts, including cultural background, race, gender, sexual identity, religion, and core values. Understanding a person’s background is important, as how we perceive others comes first from our own assumptions about them. Sometimes those assumptions are based on biases.

Understanding unconscious bias is the first step toward cultural competency. Once you are able to understand—to a degree—where someone is coming from and what makes her who she is, while truly checking your own biases, you are more likely to understand her motivations, thereby making a more authentic connection. This can lead to better decisions when dealing with an injured worker in a workers compensation claim.

The Numbers

According to the U.S. Census Bureau, in 2018, there were approximately 328.2 million people living in the U.S., with 62.9 percent of people 16-years old and above in the civilian labor force. Foreign-born persons make up 13.5 percent of that figure. When looking at the composition of the labor force by race and ethnicity, 78 percent are Caucasian/white, 17 percent are Hispanic/Latino (61 percent of which are Mexican), and 13 percent are African-American.

By 2025, the immigrant (foreign-born) share of the population will surpass the peak it reached during the last great wave of immigration a century ago. By 2050, Hispanics will make up 29 percent of the U.S. population, compared to 14 percent in 2005.

Additionally, there is a correlation between race/ethnicity/nationality and the types of employment/occupations held. For example, one BLS report showed Hispanics were substantially overrepresented in certain occupations, such as construction/maintenance, painters, agricultural workers, and housekeeping/maid jobs. Not surprisingly, the evidence suggests members of minority populations face higher workplace injury risks compared to their white counterparts, as those individuals are generally working in jobs with a higher risk of injury.

A study by professors at the University of Southern California and Boston University found that foreign-born Hispanic males had the highest number of lost workdays following a work injury, with the second highest being Hispanic males in general. Another snapshot that examined age as well as race and ethnicity found that black males age 50 to 64 had the highest number of lost workdays/disability, with the second highest being foreign-born Hispanic males aged 50 to 64.

Meanwhile data from the Census Bureau and the “2018 American Community Survey (ACS) Public Use Microdata Sample (PUMS) One-Year Estimate” found that, as of 2018, 57.9 percent of adjusters, appraisers, examiners, and investigators were female. Of that group, 71.6 percent were white and 17.7 percent were black. Asians make up the third largest share of this group, while Hispanics were not even in the top three.

Putting It All in Context

Why are these figures relevant? More than likely, the average claims professional will be dealing with an injured worker who is from a cultural, ethnic, or racial background different from her own, or who may not speak English. An authentic connection between the injured worker and the claims professional can be critical in managing claims costs, such as medical treatment and lost time as well as ancillary claims expenses.

Claims professionals are not the only ones who face challenges dealing with a diverse injured worker. Unconscious biases or lack of cultural competence regarding perceptions of health care and medical treatment permeate health care systems. Some studies, such as the Agency for Healthcare Research and Quality’s findings on the “National Healthcare Disparities Report,” show that, historically, members of particular racial/ethnic groups received poorer standards of care due to the bias of health care providers. This, in return, can impact compliance with medical treatment, trust in the physician/patient relationship, and, ultimately, treatment outcomes and delayed return to work.

The claims professional/injured worker relationship must be built on trust and empathy if it is to be successful. A claims professional’s primary job is to ensure the injured worker receives accurate information on her claim, proper medical treatment, and adequate information on her rights. However, claims professionals must also investigate claims, determine compensability and any defenses, and maintain low claims costs where feasible. Accordingly, it is a complex relationship already, but even more so when you add in additional barriers that may be present when dealing with a cultural/ethnic/racially diverse injured worker.

A claim where there is no cultural/ethnic/racial barrier between the claims professional and injured worker can have standard expected claims costs, including medical treatment; indemnity; vendor expenses such as transportation and prescriptions; and possibly case-management costs if the claim warrants a nurse case manager. The anticipated claims cost in such a standard claim is easily quantifiable.

Once barriers are added to that process, particularly where a claims professional is not culturally competent and the authorized physician is not sensitive and thorough in treating the patient, additional claims costs will be a natural consequence. The additional expenses can include translation/interpreting services, transportation services, and additional indemnity expenses. There are also additional soft costs, such as longer time periods for obtaining a recorded statement, investigating the claims, or simply building trust with a diverse injured worker.

Insurers should strive to not only hire diverse adjusters, but also train them on cultural competence and unconscious bias, as well as provide them with the necessary tools to deal with a variety of injured workers. Claims professionals, like all of us, should work on building an authentic connection as best as possible. This can be as simple as knowing to ask injured workers the right questions—including their general feelings about medical providers, willingness to accept and comply with medical treatment, and any desires and/or barriers that may exist on their willingness to return to work.

At the same time, claims professionals will need to rethink their reserves on the front end of a claim and invest in additional potential expenses to hopefully reach a better outcome in the end with an overall lower claim expenditure. This includes knowing how to properly staff their claims with the right treating provider and nurse case manager, as well as anticipating expenses, such as interpreter services and transportation services. The goal is to strive for cultural competence and understanding at all levels in the chain of a claim to achieve a more seamless administration. The “payoff” could significantly impact and lower claims costs by achieving better compliance, treatment outcomes, and reducing the length of the case.