It’s one of the great ironies of modern life: more of us carry phones, but fewer of us use them to actually talk to one another. We text, we tweet, we email, we play Angry Birds. But we seem to have an increasing aversion to conversation – and for insurers this comes at a cost at claims time.
A recent RGA study of North American group disability carriers revealed some eye-opening trends: a growing number of insurers are not performing disability claimant telephonic interviews at all. Even when interviewing is part of the claims process, many claim analysts rely on a script, which often results in rote “yes” or “no” responses, rather than doing the preparation and active listening that can clarify the claim and communicate important information to the claimant.
In an era of big data, telephonic interviews remain the disability claim analyst's most effective tool. Disability claims are complex; the contract language can be difficult to understand, and underlying circumstances can be difficult to assess. In many ways, a claim is like an iceberg, with most of the bulk hidden below the waterline. Initially, the carrier can see the information revealed in forms, but what lies beneath – other medical, occupational, and personal factors – often has greater influence on the likelihood of a return to work.
A phone call can help reveal the full picture. The claim analyst can create a rapport that prompts the interviewee to volunteer more information, including the true nature of an absence or the claimant’s motivation to return to work. An effective interview can help the claim analyst draw out not just the work the claimant cannot perform, but also what he or she can do. This is vital in developing the case management plan and coordinating appropriate resources.
Three Keys to Effective Interviews
RGA’s U.S. Group Re is developing a new e-learning module and game for clients that coaches personnel on ways to conduct effective claimant interviews. Key insights from the module are mostly common sense, but provide important reminders for claims staff:
1) Know Your File
Prepare for the call in advance. Call at the right time of day based on the claimant’s time zone, and understand who you are calling. Will there be a language barrier or generation gap? Is this person going to be angry or resistant? Anticipate these potential challenges and have a plan to address them in advance.
Become familiar with the claimant’s policy details, current medical condition, and reported functional abilities, occupation, and duties. Also consider BPS – or biological, psychological, and social risks that might not be readily apparent in claim forms.
Preparation will pay off. By formulating questions to address information gaps, the claim analyst can more quickly confirm what is known and address what is unknown.
2) Make it a Conversation – Not a Checklist
Conversations can be unpredictable and challenging. When we talk, we must take turns, and our responses may change accordingly. An interrogation based on a checklist, on the other hand, can be much more formulaic and limit information-sharing. Conversational questions are often open-ended and designed to gain insight on feelings and perceptions. Checklist questions, on the other hand, are often closed, forcing brief one-word “yes” or “no” responses. Examples may include “Do you smoke?” or “Did you see your doctor.” Such questions confirm information that is likely already known, but do little to fill in missing pieces.
Conversational templates should only be used as a guide, and closed questions kept to a minimum:
- Introduction - As the face of the company, appear in command of the claimant’s information but also empathetic and approachable.
- Questions - In asking about events that led up to the work absence, review medical details but also explore the impact of the illness or injury on the claimant. Ask how the claimant feels and how the event changed his or her life to gain a fuller picture of the situation. Ask the claimant to define barriers to recovery and personal expectations and goals. This helps address abilities – not just disabilities – and might reveal information that would aid in case management.
- Closing - Always summarize next steps, offer to answer any questions, and thank the claimant.
The file summary should avoid rambling, narrative statements, highlight key points, and remain neutral and fact-based.
3) Practice, Practice, Practice
At a time when many of us have more digital discussions than real ones, it is more important than ever to practice the art of conversation with claimants. Increasing the frequency and flexibility of telephonic interviews can help insurers gain a more complete view of each claimant – and better outcomes for everyone.