“How can invalidity claims be managed – applying strict, legalistic definitions – and yet reduce anxiety and defuse anger as such processes provoke?” I addressed this question at the recent Conexus Financial Group Insurance Summit, where I explored how I reviewed an invalidity-claims process for a public sector super fund, leading to a halving of the approved claims.

But more compelling was that later, this revised process – which might have seemed more ‘mean spirited’ given the lower approval rates – really came into its own when I was asked to manage the invalidity claims of Tasmanian public-sector employees who had been affected by the Port Arthur massacre.

Critically, this is a story about how relying on “only” the letter of the law (PDSs, disclosure) does not either engage or inform those involved in the claims process. Unfortunately, in this risk-averse time, we appear to be heading in the wrong direction.

Starting my career as a young idealistic lawyer, I was captivated by how the words and processes of the law could deliver justice – for everyone. I then went to a state bank as a lawyer, running its corporate super fund, among other things. It was small enough to infuse a sense of fairness into the finer details of implementing processes. After a role in local government, I then became executive manager of advisory services at a Tasmanian public-sector fund.

After I’d been there about six months, the CEO noted that the approved total permanent disablement (TPD) claims were rising, asking me to become the board delegate and investigate.

Efficiency and justice are not conflicting goals
In this context, everyone mostly wanted to do the ‘fair thing’ but it turned out that different stakeholders had slightly different ideas about how to apply the rules. Hence, the progressive drift into more approved claims. Had their respective understandings been tested?

Employers were the stakeholders most concerned about changes to the process. It took many meetings, sharing concerns and putting the claims process into the context of employer (government) funding a defined-benefit scheme and the impact on member fees before the employers started feeling that – while not overly comfortable with the changes – at least they understood what they were and why they were occurring. The medical practitioners, while not affected by the changes, were grateful to put a face to the fund and have someone explain the technicalities of the process – for the first time!

The most confronting part of the stakeholder-consultation process was visiting, in their own homes, those members who had either been denied or granted a disability benefit. I wanted to find out whether these members understood why their benefit had been denied (if applicable), and, for all, whether they understood the process, forms and the language.

From the visits, I gleaned the following insights and we implemented these changes:
• The language of the forms was not understood. Simpler explanations (while referring back to the longer definitions) were included and tested in the field with real members.
• Member communications about insurance were changed.
• Members wanted to be able to speak with one person – not an anonymous contact centre.
• Because the staff were involved in visiting the members, a set of listening tools and an insurance lexicon was drawn up and used.
• For those members who had been denied a claim, they wished to know the reason. The fund, while realising this may affect subsequent court action, included clear reasons in all denials of claims – tailored to the actual situation rather than pro-forma ‘reasons’ from some menu – reducing reviews of claims.
• Everyone had to be working off the same song sheet about the definitions and processes.

Compassion without clarity, while well intentioned, can lead to misunderstandings which, in turn, can contribute to a deterioration of the very conditions being dealt with (“the process of making a claim was such a trauma it made me worse”).

Approved claims were halved while also reducing thecalls for reviews.

The secret here is simple: telling is no substitute for informing. When someone is ‘informed’, it means they actually understand, and this can be confirmed by checking if they pursue actions consistent with that understanding.

Process under pressure
On a sunny day in April 1996, Martin Bryant went into the Port Arthur historic site and killed 35 people and wounded 23 people. I was asked by the CEO to personally manage the invalidity claims from the 16 or so public-sector employees who were at the Port Arthur site when the massacre occurred.

I can still remember going into a room near the Port Arthur site to see a group of people – the claimants and union officials. Some of them had witnessed the shooting and some had also lost family or friends.

It was a very different situation to an individual claim. All of them were in deep shock – and moving around the room together, like a clan of people sticking together to ease the pain.

How to gain an understanding of the invalidity claims process in this situation? Remember that this was amidst a general sense of shock. Today, this part alone may well have had a threefold engagement by professionals: the claim-process people, the grief counsellors and the communications and public-relations experts who would help ‘frame’ the situation for the major stakeholders. Of course, the claimants were also separately seeing medical and counselling professionals.

In the context of those government employees affected, there was the initial challenge of forming a bond of trust. It was both for the claimants and myself a time of listening, reiteration and, for me, gradually gaining trust from the group over many meetings. It took time, but once trust was established, the group began to dissolve into sub-groups and then individuals. Finally, people wanted to resolve their own situation and sign the form. This was part of their grieving process. Individuals – or twos and threes from the group – would come to sign the forms.

A critical and special moment for me was when again explaining the options to one lady and she panicked and said “I just don’t understand”. I asked her gently to relay what she thought she understood. She progressively outlined each of her options, and I was able to say – to her amazement – yes, you have that right.

In a highly traumatised and politically sensitive situation, the claimants were listened to, their cases personalised and the forms were signed without any complaint either from the individuals or the media.

Thus, rather than split ‘claims’ (via insurance), ‘grief’ (via counsellors), and ‘political impact’ (via spin doctors), there was a momentum to resolution that achieved the result – a social recognition of personal loss articulated through an informed view of what was feasible, fair and focused on the individual.

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