Risk in Claims Management

by | Apr 29, 2024 | claims management, Risk Basics

When I first began my career in risk management, my new boss told me that the credentials after my name were impressive, but the legal experience behind them was lacking. My boss explained to me that I would be working under the direction of outside legal counsel who needed to teach me how best to defend my entity in documenting a claim file as directed. While the truth hurt at the time, what followed was a tremendous experience that shaped my career.

Assigned to outside legal counsel, I learned how to understand a claim – how it may have occurred, identifying the people involved and their roles – all helped shape the intricacies of the documentation needed within each case file. My “teacher-lawyer” taught me that each claim has a story to tell – good, bad, or ugly. The importance of the story lies in the characteristics of that one moment in time that try as we might is difficult to recreate. Learning to document the entire complexity of the information available was central to learning the claim’s back story.

I learned claim files have order to them. There are specific folders for specific types of information. Each folder within the file has its own story to tell regarding the claim. Facilities, equipment, and maintenance records give a description as to the physicality of a claim. Medical records and IME’s provide documentation as to the human component of injury. Payroll, work schedules and employee records paint the human activity component surrounding what may have transpired and what happened next.

Respect in relationships is also important. Risk managers seeking documentation need to instill trust and confidentiality. My legal counsel explained that employees sometimes withhold documentation because of mistrust in a risk process or anticipated outcome and that documentation is given when risk relationships are genuine and honest. She hit home the point that the process of gathering information needs to be non-judgmental with no opinions needed or given.

I remember having delicately put together my first complete case file for legal counsel review. When I gave it to her, she took the time to review each individual folder – discussing it and the information contained therein. As she finished, she stated that I needed to prepare to attend the depositions associated with that case. She explained that my presence was important as a representative of my entity and to the employees called in its defense.

“You’re the security blanket Marilyn” she said. “You have collaborated with your team to gather their documentation for this case file. They have learned to collaborate with you and trust you, and now you need to be there for them as they tell their part of this story. I need you to be my wingman to help me with all the stories I am about to hear to determine the case liability and its conclusion. Our journey involves teamwork of the highest order – public trust.”

Thirty-five years ago, that thoughtful lawyer took the time to teach a young risk manager the nuances of successful claims management. My risk travels took me to national healthcare, information technology, teaching, and public service. Her journey took her to the federal judicial bench and a legacy of excellence in governance.

I have always embraced the knowledge and partnership in risk she generously shared as I share it with others. Risk is a partnership that requires the respect of professions and the information shared. A claim’s journey begins with information gathered from that time-space continuum but evolves into the partnerships formed in its journey to case file conclusion and the support given to bring it to a successful conclusion. Risk management is essential to successful claims management.