ADJUSTED
ADJUSTED
Season 7 Wrap Up
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In this episode, ADJUSTED welcomes all the Co-Hosts and Crew from season 7 to discuss and reflect on the episodes they hosted.
Season 7 is brought to you by Berkley Industrial Comp.
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Hello everybody and welcome to Adjusted. I'm your host, greg Hamlin, coming at you from beautiful Birmingham, Alabama and Berkeley Industrial Comp. And with me today are a whole group of people, as today is our season wrap up, season seven, which is hard to believe. This is actually episode 94, which is crazy to think that we are approaching our hundredth episode of adjusted. It's been almost four years. So we're going to have some fun today going over season seven and touching base with everybody, and before we do I thought I would just kind of go around the horn and touching base with everybody, and before we do I thought I would just kind of go around the horn and have folks introduce themselves. So we'll start with you, mike.
Speaker 3Yeah, good morning, slash afternoon, whatever time it is, wherever you are, mike Gilmartin, with Key Risk. I'm based in Greensboro and it's currently raining like cats and dogs, so I'm glad to be inside.
Speaker 2Yeah, for those who don't actually this audience wouldn't know, but we had a lot of technical issues today because of the storms that are coming that direction. Mike, you're in North Carolina, that is correct. And then we also have Sam Neer with us. Sam, you want to introduce yourself? We've had some technical issues with him today too.
Speaker 4It's always fun to actually. You know, the technical issues have to go with the tech guy right. So Sam Neer was Berkeley Alternative Markets Tech. I am the Director of Product, with a concentration on claims and trying to weather the storm, but also loving the fun that comes with tech issues, but excited to be on the podcast today. And, Sam, where are you out of? Again? Raleigh, North Carolina. Again, not as nearly as cool as Greensboro area with Mike, but we do have some great basketball down here, so can't complain too much.
Speaker 2You know I love basketball, but those colors are not mine. We'll switch over to Matt. Matt is in St Louis. You want to introduce yourself?
Speaker 5Hello, this is Matthew Yaling. I'm with Midwest Employers, casualty. I'm in St Louis, missouri, or Chesterfield is the suburb we're out of, but along the banks of the mighty Mississippi here in the middle of the country. Look forward to today's discussion.
Speaker 2Glad to have you as always, Matt. And then we also have an old friend of mine here with us today, Hope Rometa. Hope, do you want to introduce yourself?
Speaker 1Hey, thanks for having me. My name is Hope Rometa. I'm with Berkeley Industrial Comp and I'm sitting in Lexington, kentucky. It's actually really gorgeous out today. Sorry for the rain.
Speaker 2Kentucky is pretty awesome. You get mild winters, but at least you get a winter and your summers aren't as hot as we find ourselves in Birmingham right now, where it's been close to 100. So I think that's everyone. I always want to acknowledge a few people who are in the background who do so much for the podcast. So, starting with Jacob Holmes. Jacob edits a lot of these episodes and I always say he is the equivalent of my teenagers who have filters on their phone. He makes sure we all sound amazing and look amazing. Teenagers who have filters on their phone. He makes sure we all sound amazing and look amazing. And all of the gaffes and missteps he cleans up and technical issues. So huge kudos to Jacob. Also in the background, we have Cindy Housel. Cindy has stepped into a new role helping us out with the blog that we post, so we're certainly excited for all the efforts she does, both to update the podcast on LinkedIn as well as to work on the blog, so kudos to her. And then also in the background, we have Gabriel Santos, who is our marketing guy. He's new to Berkeley Industrial Comp and we're super excited to have him with us as we continue to move forward with Adjusted in the future.
Speaker 2So obviously, when you listen to this, there's a lot of other people in the background that make it happen, so making sure to acknowledge them is important. So I wanted to just really quick. I always like to start with this. Matt and Mike have been along for the ride for a while now, so I think we could almost host these episodes in our sleep. But for Hope, she's helped out and been involved in different ways. What was it like for you, hope, as you were helping host the podcast?
Speaker 1I always find podcasts challenging. Honestly, it's fun but it's challenging because I'm a super curious, intuitive person and I tend to ask a lot of questions, but it's not always super conversational so to make it interesting to listen to, I find it challenging, but it was fun. Oh, that was a fun experience.
Speaker 2We gave you a super easy topic CMS, right Like that's the most interesting topic there is
Speaker 2if we were going to do it, but having done a podcast now for four years, I'll tell you I have a lot of respect for when you start to see people who do lots of interviews, of how hard it is and how easy they make it to get people to really open up and talk about things and keep it interesting. So I definitely feel that for sure. I really think, Hope, you're our CMS expert. In fact, we just had another operating unit asking me some questions about whether to submit or not submit and I said you know I could give you my opinion, but it would be better for you to talk to Hope, who's really the expert on this, and I know you've spoken at WCI on this topic as well. What were some of the things that stood out to you, Hope, as we went over the new rulings with CMS?
Speaker 1Yeah, so the big ruling that we talked about was the final civil penalty ruling, where it talks about how important it is to report when we first get a case and we're making payments on a case and then when we're terminating it. And historically there's always been recommendations, right, and we've had some penalties associated with it. But with this final ruling the penalties are significant, like significant, significant. So we're talking about the ORM date, which is the date of which basically states hey, I've accepted the claim and we're paying on it. And then at the end of a case, when we've terminated the medical piece of it, we're doing what's called a TPOC and it's a termination that basically tells Medicare hey, we're not paying anymore, but here's a settlement and this is what we've allocated for the same right. And they are giving us some leeway of a year to have all that update in the system. So if I'm reporting an ORM today or I should be today I've got a year to actually get that in the system and do it correctly. If I don't do that correctly, post a year, your fines and penalties are from $357 a day. That's on the low end. That's the least you'll receive per day per claim and the max of inflation right now for this year, is $1,428 per day per claim, so it's significant.
Speaker 1It is not a mistake you want to make, so I think that probably stood out to me. The most is how intense the penalties are. And then I think, historically, medicare is still kind of in its infancy stage. Right that Medicare is really only not Medicare, but when we're talking about it in a comp perspective, a work comp perspective, really only not Medicare, but when we're talking about it in a comp perspective, a work comp perspective it's really only been around for us since really the early 2000s and been a focus, and it keeps developing. So you're always going to see changes like this. And heck, it's taken them like 18 years to come up with this ruling of civil penalties, so we've had a long time to get it right. Now we just need to ensure that adjusters are making this a priority and getting it right within the first year.
Speaker 2I couldn't agree more and I'm always surprised. I always feel like whenever we do a Medicare podcast, I'm like boy, no one's going to want to listen to this and it ends up being one of the highest listened to episodes. So I know there's a lot of questions and a lot of interest around trying to understand it and make sense of it. So certainly appreciate your expertise and definitely recommend people go back and listen to that one or just reach out to some of the experts we've had over the last four years. Dan Anders is amazing, Heather Sanderson's amazing. These are great people, great resources. If people don't know what to do when it comes to Medicare and if you don't want to make mistakes, I would really encourage you to reach out to some of these industry experts.
Speaker 1I mean, it is an exhilarating topic, so I don't know who wouldn't want to listen to these podcasts.
Speaker 2I always feel bad about that. I'm like, here we go again. No one's going to want to listen to this. And then I look at the numbers and I'm like, wow, a lot of people actually want to know this stuff.
Speaker 1So that is good. Well, it's necessary, right For your company, it's genuinely necessary. The fines are so significant that it can be detrimental.
Speaker 2So look for us to revisit this again. I think you'll probably keep seeing this come up over the next year or two as we continue to kind of see how CMS handles this stuff. So definite thanks to Hope for that one. From there we went to claims management, which is an interesting topic. Mike and I tackled that together. Mike, what stood out to you from that episode?
Speaker 3Yeah, I think the biggest thing for me, especially thinking about when I became a manager of folks handling claims and I think, Greg, you said the same thing but realizing that not everybody has to do it the way that you do it, and that good can look good in different ways, and being able to be comfortable with stepping back and saying, hey, so and so does it.
Speaker 3Very different than me, but they get really good results. Not only that, but how does that person get good results? And how do I then give that to other members of my team to say, hey, they do this really well and you do this really well. How do we get together to make sure everybody's kind of learning from each other? Because a lot of times you see claims managers who like this is the way you're going to do it and it's the only way you're going to do it, it's the only way good looks like, and so that's tough. And so I think we talked a lot about empowering our adjusters to make decisions and figure it out right and make mistakes and learn from those mistakes, and so that's the biggest thing that stood out to me, Greg, I don't know about you.
Empathy, Psycho-Social Elements, Tech
Speaker 2I love that episode. It was one of my favorites. I think claims management is so important. I think some of the people who leave the industry, it's because of bad management to be honest, not always, but I think sometimes and there's a real opportunity for us to improve in that area, and I had a great time doing that episode, just talking through it. You know, I'm onboarding a new manager now and it was really interesting. He's getting to know his team and we were working together side by side, and he said, hey, I'm just going to quick jabber this adjuster this information. Then he said, wait, I remember this adjuster doesn't like jabbers or messages, she likes a phone call, and so I'm going to save this and I'm going to call her and I was like good for you. So just recognizing what people need and how they communicate is so important and there's a lot we can do to get better there.
Speaker 2From there we went straight into empathy for adjusters, and this was a crazy topic, one that I would have never thought of. I was at Nationals for Disability Workers Compensation in Vegas and I had the person we interviewed approach me and say I'd love to do a topic on empathy for adjusters. This is an incredibly hard job and we talk about empathy for everybody else, but we haven't actually talked about empathy for the people who are having to do this balancing act, and so that was a lot of fun for me to take the topic and kind of turn it inward, when normally we're spending most of the time looking outward at how do we improve empathy with our policyholders and our injured workers. So I do think that this is a difficult job and we probably need to do a better job of recognizing the great work that our employees do to help injured workers and manage policyholders and manage medical providers. It's a lot. So that was definitely an interesting one, matt.
Speaker 2From there we went to psychosocial elements of claims and you tackled that one with me. What stood out to you on that one, matt?
Speaker 5Yeah. So we booked a Dr Alex Korb and I think, you know, as we talk about empathy for adjusters, we have to have empathy for the injured employee as well too, and I think, just realizing that as adjusters we're dealing with these claims, hundreds of claims every day, we see these terrible events, terrible life-altering things, and we have to remember that the injured employee, this is their first experience right, for most injured employees, hopefully it's their first experience going through the workers' comp system and everybody comes with something. Everybody has psychosocial issues. So I think we talked a lot about the downward spiral and then the upward spiral was the name of his book. So I just think we have to remember to connect with people where they're at and remember that we all have good days, we all have bad days, we all have things going on, we have life happening and let's help with the upward spiral versus contributing to the downward spiral, especially for new injured employees and they're probably in a tailspin or a downward spiral. So, you know, helping understand that and backing up, you know, when we talk about how we relate and how we connect with the injured employee, like that's, you know, an important component to remember that this is their first experience and let's not, you know, make it worse.
Speaker 5And you know how can we change the industry? If we can change how we treat the injured employees and the perception of their process, going through the workers' compensation system, I think would be be a big change. So it's a very interesting topic. He was very knowledgeable and, yeah, it hit home because I have some personal family stuff and I think you referenced some family stuff you were going through in the episode too. So, good resource, just remember. To what do you say? Be kind, do well.
Speaker 2Yeah, that's exactly right, and he probably was one of my favorite guests we've had in a while, just because he doesn't live in the workers' compensation space, he's an academic and it was just interesting to hear his take on some of these things that I hadn't really thought about. And he did say I was a high-performance sports vehicle, so that moved him up in my list of favorite people, but it was just a good overall conversation to think about. Sometimes we get upset with the parts of ourselves or the parts of our injured workers that aren't the way we want them to be, and I think just his level of acceptance and teaching people how to accept who and what they are and then work within those, I just thought was wonderful.
Tech, AI, and Pharmacy Benefit Managers
Speaker 2So, definitely one I recommend folks going back and listening to, and then from there I brought my good friend, sam Neer, with the topic of claims tech, ai and analytics and I feel like, anywhere you go right now, ai is the topic and analytics has been the topic before that. I've had the opportunity to go to Reuters and speak and met James at that conference and I thought he would be perfect for this topic. Sam, what were your thoughts when we met with James?
Speaker 4Yeah, I really enjoyed the conversation with James, especially because he talked everything from what technology is doing great to even the misconceptions there. And one of the things that really stood out to me from the conversation is the good uses of technology is when it can give you a good picture of what's breaking early in the process. Right, it can be that early warning system and things like that. But on the flip side, as we know, sometimes things break on technology, surprise to the listening audience and a collective gasp. Right. But when technology doesn't work out, how do we basically keep people in the forefront during that time when it's not working? Right? So, thinking about how to communicate, how to empathize with your person who's dealing with this technology issue just like we talked about earlier trying to pick up the phone and call someone because they prefer it let's do the same thing with technology.
Speaker 4And finally, one thing that stood out to me is when we thought that AI was going to be the savior of all problems the big thing in the sky will solve all the issues and surprise, surprise, another gasp. It's not right, but a better way is really to deploy this new and emerging technology around data and analytics and AI to solve very specific problems. Let's not boil the ocean, let's not try to do everything. Let's find a very specific problem that doesn't require nuance and let's use AI to try to attack that. So those really enjoyed the conversation. That was sort of scratching the surface of the episode, but it really made me step back and think of someone who's in technology all the time. How do we challenge our conceptions but, most importantly, keep people in the middle of it?
Speaker 2I couldn't agree more on that one too. Sam and I was actually in the airport coming back from a meeting with Sam yesterday and I was having a discussion with an adjuster who was in the airport with me and we were talking about AI and she's like, well, the point of all this is to eliminate everybody's jobs, and I said I actually don't think that's what's going to happen. I think that there'll be new skills that people need that people are really good at, and some things that are menial and probably are the least favorite parts of many people's jobs are going to go away. A lot of the data input, a lot of the sorting, a lot of the reading large amounts of data so there's going to be a place for people in all of that.
Speaker 2I really still strongly believe, and I think there are some real misconceptions about what AI is and, being a sci-fi nerd, I always just think of it as when you see these space shows where someone's in a giant mech suit and they can do all these cool things like think Iron man, that AI is going to give us the power to do so many more things, but there's still going to be somebody in suit that's going to be working the machine. So interesting topics and then from there, matt, we went on pharmacy benefit manager topic and I know this is one that for some people they might not think it's really important, but one of the things I've learned, being in claims a long time, is you can lose a lot of money if you are not paying attention to your pharmacy benefit manager. Matt, what stood out to you as we went over this topic? I know you see this on the excess side all the time- Right.
Speaker 5I think you hit on it right there. Right. The devil's in the details. Partnering with the right pharmacy benefit manager and understanding their program and making sure really that they understand your program is super critical, and that's really what hit home for me on this one is you have to have somebody that if you have a lot of injured employees and you need that first fill and that's what's the cost driver for you. If you have a lot of frequency, then make sure that program's set up right. If you have severity and you have a lot of high-cost medical drugs related to severity claims, that's what's driving your costs. Make sure they understand that and it's the devil in the details for these types of things.
Ideal Caseloads and Talent Retention
Speaker 5So it's one of those things you kind of geek out with. It's an interesting interview and a lot of knowledge in that one as well. It's the second time we've had Ron on the podcast and a lot of good information on both this one and I think I don't remember if it was last year, or season four, six or five, or which we talked to him previously about too but good information in both of those.
Speaker 2Yeah, I really enjoy Ron. I'm going to get an opportunity to teach with him at Claims College here in a few weeks. So, for those who listen, if your carrier doesn't participate, it might be something to look into. They do a CLM Claims claims college and a bunch of different leaders across different organizations volunteer to be the instructors. So it's a great opportunity for people to learn from people in from various carriers across the country that all team up to do this, and it's not just workers comp. They have specialties in pretty much all lines. So if this is something that interests you, I would recommend you reach out. You'll see, ron, why they're here and why they enjoy what they do.
Speaker 2And if there's one thing that keeps me up at night the most, it is, honestly, people entering claims. Is the industry preparing the next generation to step in and do these roles? And, as so many people have gone remote, how are people going to figure that out? And who's going to take the initiative to train those people and then also retain them after they've been trained? Because if we're all fighting for the same 10 people, it's going to be a pretty crazy market. So this was a really important one to me. I think it's one that I hope that the industry takes to heart. I hope that not just us, but many others are putting time into developing new adjusters and helping them find their way into this career, because it can be a very meaningful career for folks and I think we tackled that and there's people like Mike who are like I'm out of claims, I'm going straight to business development. I got to get out of here as fast as I can.
Speaker 3I've given 13 good years. Buddy, that's not getting out. As fast as I can, come on, give me a little credit, all right.
Speaker 2All right, we'll give you that. We'll give you that. No, there are so many opportunities once you get into insurance, whether that's specialties like catastrophic claims or going into leadership or even pivoting into other areas, so I like to give them a hard time, but we're still glad to have them on here as part of our crew. From there we went to Ideal Caseloads. Mike, this is like a crazy topic to go on and it was funny because one of my adjusters at the end listened to it. He goes so what's the number? You didn't actually say the number and I was like, huh, I guess we didn't actually get there, and I do think it depends, which is a hard thing to say, and I think we tackled that, mike, but what was your take on that one?
Speaker 3Yeah, I definitely think it depends, right. I mean, I think some points were made that if you're sitting in California and LA County or what have you, you probably need less claims than somebody who sits in a friendlier jurisdiction. Or if you're new versus old, or if you've been doing it a while, or complex claims versus you know your run of the mill claims. But I mean, the biggest thing that always stands out to me on this is, even from when I first started in claims to now, we've asked our adjusters to do so much more stuff. Nowadays they have to click more boxes, they have to know more information, they have to be experts on 1600 different things, and so it just adds to the level of difficulty for an adjuster.
Speaker 3And so, as that continues to go up and rise, it's really hard to say that the number should be 125 or 140 or 110 or 100. I think it really does depend. But we ask our adjusters to be experts in so many things. I think the less claims you can give them, the more likely they are to succeed. So I just think we spend a lot of time in claims not setting people up to succeed and then asking them to pull out a miracle, and that's a really tough way to work on a daily basis.
Speaker 3That's what I've always took out of it and that's how I've always felt, even when I was handling claims. You give me 100 claims, I can do it really well and I can do it successfully. If you give me 175 claims, I'm still a good adjuster, but I'm not going to handle that successfully. I'm going to put out fires, I'm going to call the people that are burning up my phone the most and I'm going to try and live for another day, and so it's a very tough job. I don't necessarily miss the day-to-day of claims, if I'm being honest, but there's an ideal caseload and the managers that recognize it and the companies that recognize it and say, hey, we need to invest the manpower in doing this right because the money you save down the line from a claims cost perspective is so high. I don't know why more companies don't look at it.
Speaker 2I think it's an incredibly important topic and I think a lot of times people are so, companies are so focused on throughput they're not thinking about outcomes, and outcomes are really, really important and planning and claims is really, really important, because people leave and the conveyor belt of claims runs whether the people are here or whether they're not here, and if you burn out your talented individuals, then you have a much larger issue, and I know numerous organizations TPAs, carriers that have gone through phases of this where they didn't think that part through well enough and got themselves in a bind and then their good people went other places, like us. So I'm glad to take them if they leave, but it is an important thing to keep in mind Claims are like plumber the more you do, the more work you generate, right?
Speaker 5I mean, yeah, it's you know. So I mean that's my opinion on that topic, but you have to do the work to get the outcomes that are good.
Speaker 3But yeah, it's tough, that caseload question A lot of times, matt, we take our best adjusters right Because generally they can handle more and we just keep giving them more and more and more and at some point that person is just not going to I mean, it's going to drive your best people away no-transcript. It's like the answer always is like we'll give it to someone, so they're awesome, they'll figure it out.
Speaker 5Benjamin Franklin said it best If you want something done, give it to a busy person. That's what claims is.
Four Years of Podcast Success
Speaker 2I'm on the top of that list with six kids, so my life is incredibly busy. First day of school today, so we're going to be dealing with that when I get home, so hopefully it goes well. Hey guys, I want to just to thank all of you guys. I never would have thought four years ago when we came up with this idea it was actually the summer of 2020. So it's literally been four years. A lot of different players back then, many of them gone, and the podcast is still here four years later.
Speaker 2We've run every two weeks now for nearly four years. I think we launched in November and we started the planning in July, and we're approaching our 100th episode, which is pretty crazy. We're in a very small segment of podcasts that have actually survived that long and has over 30,000 downloads, which is pretty cool. So I'm just really proud of what we've done together as a group. I know a lot of those probably are our moms or people going to sleep, but I do. I'm always surprised when I go to conferences and run into people the people who are listening who I never have met, don't know, and who appreciate what we're putting out there. So I'm excited to see what the future holds, appreciate everybody here and I'm looking forward to an amazing season eight, where we hit our 100th episode and celebrate four years of doing this thing. So thanks again to everybody, and I remind our audience to do right, think differently and don't forget to care. And we'll keep this going every two weeks going forward, as always. So thanks everybody.