Tuesday, December 22, 2015

Form Letters

In October, 2015, a story was published about some letters sent regarding workers' compensation claims in Ft. Worth, Texas. At best, the letters were insensitive. It may be that the furor over the letters is worse because of previous issues with the city's workers' compensation program.

In workers' compensation some businesses buy insurance, and the insurance company, or "carrier," covers the risk and provides the adjusting of the claims. Some employers instead "self-insure" the risks, meaning that the employer will be responsible for losses. These are usually large businesses or in some states smaller businesses may form groups for this purpose. Some really large employers hire adjusters and do their own management of claims, check writing, etc. And some of these self-insured employers instead hire a third party administrator, or "TPA," to do their adjusting and management of claims. The TPA model seems to be the more common approach for self-insureds. 

Ft. Worth's workers' compensation program is administered by a TPA or "servicing agent." These companies adust workers' compensation and other kinds of risks, but do so with money that is the client's (Ft. Worth) or perhaps an insurance company (a carrier who is covering a risk may find it beneficial to hire a TPA if the carrier does not do a volume of business in a location and desires local adjusters and managers). Either way, these TPA companies are focused primarily on delivering a service. 

Recently, in Ft. Worth, this company sent out letters. It sounds as if they may have gone to a large number of recovering workers. It also sounds like they were form letters. Many companies use form letters. They are a convenience. They may help to provide information to large populations of people that have common interests.  

According to NBC 5 in Dallas-Ft. Worth, the letters informed recipients that Ft. Worth would be changing adjusting companies. So the old service provider mailed these letters to inform recovering workers of the identity of the new service company. That makes sense. The TPA would be the point of contact if a check is late arriving, if a treatment requires authorization, if a medical appointment is needed, etc. The recovering worker needs to know who to contact with questions or issues. 

Some took issue with the letters though. Specifically, the story mentions that the families of two deceased employees received letters. That seems logical, because families that survive someone killed in a workers' compensation claim may be entitled to ongoing workers' compensation benefits. It would perhaps be helpful for them to know who to contact with questions, issues, etc.

These two employees happened to be police officers. Each passed following injuries suffered in the line of duty. There has been a fair amount in the news lately regarding police officers, and the dangers that they face. Most of us face injury risks everyday. The statistics support that some occupations are more dangerous than others. I am confident that being a police office has a higher risk associated with it than being a judge. I sit at a table all day staring at a computer screen, which is perhaps very low risk, and by comparison there are some very dangerous jobs out there. 

While informing everyone of the change in companies makes sense, the phraseology of the letters caused concern and upset. These letters named the new company, the effective date of the change, and then closed with "we wish you a speedy recovery." Survivors of the two deceased employees found the statement difficult. Of course, those deceased employees are not going to recover, quickly or otherwise. As one put it, they made "the ultimate sacrifice."

One of the widows found the choice of words "disrespectful" and commented that she "hope(d) they would learn how to handle their business better." Another employee of the city was more critical, saying that "to get a form letter in this manner is just despicable."

A representative of the TPA company that sent the letters sought to reassure, saying "this oversight was not intentional," and that the company "regrets any hurt its communications caused these fine families."

Form letters. This story reminded me of having little kids around the house. I realize that seems an odd transition, but stick with me. I remember many occasions when falls and bumps led to those little kids visiting the pediatrician. I would make a co-payment, and the bill would go to the health insurance company for processing and payment. 

Afterward, the mail would always deliver an explanation of benefits, or EOB. I have a business degree and a law degree and those EOBs have never made any sense to me. I just look at the bottom line and see if there is a "+" figure (I need to send a check) or a "-" meaning I might get some money back. More often than not, there was no "-."

But more curiously, having taken a 6 year old to the pediatrician, I almost always received a form letter from the group health carrier about collateral sources (in other words, a question as to whether someone other than group health carrier should pay that bill). The question was always the same, "was this injury suffered at work?" I found these letters somewhat humorous. 

I sometimes thought about writing back and telling the health insurer that my 6 year old was injured at work. I thought of providing a long, detailed, description of the child's work, the long hours, and the resulting accident. Most parents would probably tell you that the majority of pediatrician visits involved virus or infections. The diagnosis of "ear infection" is not likely to suggest workers' compensation at any age, but I digress. 

I restrained myself from writing a sarcastic letter because I believed that anyone incapable of noting that the injury or illness was to a 6 year old might be as incapable of appreciating the sarcasm of such a letter. I also appreciated that I was already wasting money mailing back their form and more waste in the time to write a letter was not going to improve my bottom-line in the relationship. 

I also thought about writing back to them and suggesting that they, and I would save money if they quit sending those letters regarding 6 year old children. There was postage and the paper. I am fairly confident that sending the letters was an automated process, but as confident that someone at the health insurer had to open my return form, read it, make a note in some file or system. A monumental waste of everyone's time and an expense for the health insurer. But even when I sent the form back, I would often get an identical form a few weeks later. I was not at all certain that those on the other end were paying much attention to their own forms and frankly doubted they would read a suggestion letter.

Computers are wondrous tools. Keeping people informed is important, and on that level the Ft. Worth TPA should be praised for informing the workers' and their families of a change. But it seems that a computer could be programmed to not send "work related?" letters regarding injuries and illnesses to 6 year old children with green nasal discharge or "speedy recovery" letters to the families of police officers that died in the line of duty (or any families of any deceased employees). We have come a long way and computers are not the glorified memory-typewriters that they once were. 

At the end of the day, it may come down to a quote I heard many years ago, that "common sense is not that common." or, perhaps it comes down to the fact that "the devil is in the details." But it may also just come down to the fact that everyone is human and we will all periodically make mistakes? Computers are merely tools that do as we tell them, in a very literal sense. Computers do not make mistakes, but we that run them are very capable of doing the mistake-making for them. 

Mitch Radcliff is credited with the quote that "the computer allows you to make mistakes faster than any other invention." That may be something to remember. 

Maybe the computer can be programmed to do a better job on these form letters? While they are at it, perhaps an EOB can be designed that does not require a PhD. or an accountind degree to understand?


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