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We swear this story is true. Only the names have been changed.
Amanda Sue twiddled her thumbs and wished a hasty end to the monotonal reading of the company’s annual review forms. There was work to be done; cases to be opened and cases to be closed.
Amanda pulled her own weight in the 4-man special investigation unit … and then some. When the semi-annual SIU profit center statistics were compiled and published, Amanda’s initials appeared on over 75 percent of the files where savings were recorded.
“You’ll notice a NEEDS IMPROVEMENT in the area of communication,” droned the reader. “What?” queried the surprised investigator, “My files are full of every sort of communication possible, both in written form and in records of verbal exchanges.”
“The problem is,” he responded, “that the claims reps are learning too much about fraud from you. It’s not the JOB of the SIU to educate the claims people and whenever you go over a file with them, they learn new things and get better educated.”
“Are you forgetting that companies are mandated by state law to provide ongoing fraud education to their employees?” she replied incredulously.
“But at THIS company,” he said, “it is the responsibility of the claims managers and supervisors to teach the reps about fraud.” Amanda rolled her eyes as he continued. “The reps are not supposed to learn anything from the SIU—and when they do, it makes it look like the claims executives are not doing their own job.”
“So from this point forward,” he commanded, “you are directed to not discuss files with the claims reps for any reason. You’ll just have to figure out how to open the files and work them up without ever talking directly to the claims handlers.”
This is—we repeat—a true story. Frightening, isn’t it?
One more true story:
Archie the adjuster looked at the file again. “Offer just meds and not a cent more,” his supervisor ordered. “We know it’s a staged accident, but it will cost fifteen grand in legal bills to fight it. Economics, you know?”
“But there are four claimants and each has given us four grand in meds. That’s sixteen thousand dollars on a paper accident!” pleaded Archie.
“You don’t seem to understand,” said the supervisor, “it’s more acceptable to the home office bean counters if we do it this way. They would sooner pay sixteen thousand in claims dollars and no loss adjustment expense—than fifteen thousand in loss adjustment expense and no claims dollars.”
Fraud is fraud. It’s time to cut politics out of our equations. It’s time to stand up and get the job done. It’s time to make a commitment. It’s time to COMMUNICATE. It’s time to EDUCATE.
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