Beyond the Claim
Beyond the Claim

Episode 6 · 6 months ago

How To Re-Insert the Human Element Back Into Claims w/ Trecia Sigle

ABOUT THIS EPISODE

It can be scary and overwhelming for an injured person going through workers’ compensation for the first time. And, while the adversarial relationship that can be inherent in the insurance process has steered the industry as a whole away from the humanitarian piece, our guest is here to remind us just how important advocacy is.

We speak with Trecia Sigle, VP Enterprise TPA and Multinational Claim at CNA, about demystifying insurance, advocating for injured parties, and advocacy ideas for the future.

In this episode, we discuss:

  • Defining advocacy & demystifying the insurance process
  • The limits of employer control for advocacy programs
  • The future of injured individual advocacy & the COVID-19 pandemic impact 

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And if all the stakeholders and all the players involved would, you know, assume a more carrying understanding approach. I think that's how we make advocacy scessful in the industry. You're listening to beyond the claim, the show for forward thinking risk and claims professionals curious about the latest industry trends, winning strategies and stories from influential leaders. Let's dive in. Well, everyone, welcome to this episode of beyond the claim. I mean host, Mark Cunningham, chief sales and marking officer with broad spire. Today I have with me Trisha Siegel, vice president of enterprise TPA and multinational claims with CNA Fisher. Welcome. Thank you, mark. Excited to be here. Decided to have you. I've had some worked with seeing Ale pass and they'll we have a long partnership Rosbios CNA, strategic partnership at that. Appreciates you taking a time and they'll. Seeing is one of the largest commercial insurers the United States. So I'm sure your time is is is limited and very busy. So thank you for carver some out for us now. Happy to be here, Mark. Yeah, CNA and broad spire, we have we share multiple programs beyond just typical and bundle tpa work, where we are fortunate to work with you, and we also you handle claims for us in a couple of direct handle programs. So, as you noted, long relationship and a strategic partnership between the two companies. So thanks for asking us to be here. Absolutely our pleasure. So trust before we dive into the the world of claims, I loved reading your background. I think it's it's powerful that we have so many thoughts on how our careers will go over time. On were kids and you know, many folks they start of one place or they have an idea where they're going with the colleges, degrees, etc. And then their their career takes a nonlinear journey. At least that's a case for me, as I was reading your background and in law and I thought that might be the case for you. So I figured I ask a question. You know what was what's your journey? How did you go from a law degree, I think, practicing law, of I'm not mistaking, to going down the path of, you know, claims, Workers Compensation and advocacy, which I definitely want to spend some time talking about today. Sure. Yeah, so I think it's definitely accurate that I haven't, you know, stayed on on the same path and have taken a few left hand turns. But you're correct. I started out my insurance journey as an assurance defense attorney and so right out of law school practice this law and then I went in house for an another large commercial and person alliance carrier, for in their Inhouse Council program and about seventy eight years...

...in, one of the vice presidents at that company had seen me do some training work and it'd seen me operate in the courtroom and asked me if I would consider a clean leadership roll. And you know, at that point I hadn't. I hadn't really led people. I had A, you know, file clerk, couple of attorneys and a valued paralegal that had been on my team. But I, you know, I kind of went from zero to hundred and sixty pretty quickly and took over a very large team, a regional team, and kind of that's that's sort of that was the first stepping stone for my claim leadership career. Since then I have been in the field roles. I have handled a couple different lines of business in terms of leading field folks. Then I moved to a Home Office in a product role where worked on strategy and I actually led the major case unit, and that journey has led me to CNA, where I actually now oversee all outsource claim relationships for CNA, which is why I have the privilege of working with broadsire and I also have the multinational team. So anything that is not handled by a CNA claims professional generally false to my team. So that's that's kind of where I'm at now. What would you say the kind of the biggest differences between practicing law, even though it's in with an insurance industry, and actually being on the the the corporate side of how it gets a point where you need to practice law? Yeah, you know, I think it's probably the strategic thinking actually. So, you know, you spend a lot of time as a lawyer, you know, planning out a case and you know looking at a pellet the appellate perspective and there's you know, the strategic thought process is a little bit narrower. It's it's within the confines of the law and I was liked, you know, the creative aspect of it. You know, the research in the writing and the oral argument, but I find outside the legal world and in in the claims world, strategy is much bigger, it's broader, it's it's not so narrowly defined, and I like that. Of course that creates more of a challenge, you know, in terms of, you know, the the typical thinking outside the box. But I'm never bored and you know, every day as a new challenge and you know that that certainly motivates me in my professional life. So so I'll pivot a bit someone related the strategy. Advocacy is probably spoken of more now so than ever. I think it probably means different things two different individuals, but I think ultimately everyone's...

...intention is to focus on the individual, probably more so than we have in the past, and kind of treating situations the same and treating individuals the same. I saw a quote from you, you know, about not forgetting the human element, you know, and that we are here for purpose to help people. So I'm curious how you would define advocacy. What are you specifically doing in the advocacy space? Okay, how would I define it? First of all, to me it's a combination of De mystifying, you know, the insurance process, which can be scary, it can be overwhelming. You know, if this is the first time an injured person, you know has has had to deal with especially the workers compensation system. So first and foremost it's it's a demistification of the process and the second part of it is kind of adding the human element, you know, back into this arduous, what can be an arduous and confusing process. So I think, you know, on all stakeholders to a claim sometimes maybe forget that this is a traumatic event for an injured person. There's a lot of elements that create uncertainty for them. So, you know, not the least of which is wage loss, their health, the impact on their family. And I think advocacy just it allows us and helps us in the insurance industry maybe step back for a moment and reinsert the humanity into the process. And, you know, frankly, in doing so, you know, it's we're helping the injured party. Were helping them hopefully get back to normal or to get back to what will be a new normal for them. And you know, one of the elements, I think, that that we're maybe just starting to talk about is, in addition to helping that injured person were. We're also making the process of being, you know, an insurance professional more gratifying and more rewarding, and you know that's that's the piece that, you know, is certainly important to me when I look at my team's and, you know, the folks that I work with, you know in the insurance process. So would you say we went arise somewhere? You mentioned reinserting the human element. You think it was there and we know we got focused on one or two dimensions, that we're away from the human element, or do you see this as really building what was? Is Necessary to focus on the individual in a way that maybe we never happen and it went impacting you kind of overall experience and costs for employers, etcetera? That's it. It's a great question. I think it's a combination of both actually. So I think sometimes the inherent the adversarial part of the insurance process has steered us away from, you know, the humanitarian peace.

So just realizing they're still are going to be legal disputes, folks still aren't going to agree on, you know, necessarily on wages or, you know, when an event happened or necessarily how it happened. That piece of it is still going to be part of the process, but it when I do talk about reinserting, going back and finding that, you know, whatever that outcome, maybe we can treat each other with a little bit more respect and, you know, adversarial does not need to mean, you know, punishing or punitive in a sense. You know, let's let's bring the parties together and try to solve a dispute, you know, realizing that someone has still been hurt or, you know, an employer has still lost an employee and, you know, in many cases, of valuable employee. So maybe just keeping perspective. I do think that the element, in a sense, was always there and I always say, you know, when when asked, I think our nurse case managers do a nice job of, you know, being supportive and helping the injured parties. But you know, that's always been a smaller part of the process and if all the stakeholders and all the players involved would, you know, assume a more carrying understanding approach, I think that's how we make advocacyccessful in the industry. You know, if my lot of my background is on the the benefit side, the the nonoccupational side, where there's much more flexibility. You know, there's less of a jurisdictional element. Do you, when you look at works conversation, when you look at how it's govern and how that can vary by you know, jurisdictional location, etc. Do you how much? Do you think there's a enough control by the employer that a type of advacacy program that's your kind of outlining is within their control? It's doable? I mean I assume yes, but do you see that factor or that element factoring into a degree that limits what they can the impact that they can have? Yeah, the you know, the jurisdictional question is is, you know, kind of always the elephant in the room in the workers compensation world. There are certainly some states and some workers compensation schemes that are more amenable to the advocacy process, especially for the employer, since you asked about, you know, that element of the process. But even in those states where the workflow, the bureaucratic process, if you will, is is going to make it harder for, you know, the employer to kind of step back and, you know, look at the overall process. You know, remember the injured workers. You know their part. You...

...know the the again, the uncertainty. That piece. I still think that the employer can you know, what they can control is their reaction to the situation, you know, and how they treat the employee and how they look at return to work opportunities. And you know, whether or not they're being supportive through the medical treatment process. They can always control that. So, yeah, I absolutely agree. Workers Compensation as a line of business that almost more than any other, you know, line in the insurance world is is so individually driven and impacted by individual state legislative decisions and you know and and how they're enforced. If you will, completely agree. So you're looking out, you know, future state. Let's say that. We're looking at the dynamics of the employer employee. You know, you don't have, let's say, the constraints of a budget or political climate. What do you if you're building your ideal advocacy program or even this, where do you see the future of advacy going? We look out five years from now and what doesn't exist today that you would ideally like to see within you know, your ideal, you know, model or program. Sure, if I was if I had the blue sky opportunity to design, to design the process. You know, in an ideal setting, I would do a couple of things. I would, from a medical perspective, I would, you know, allow the injured party to control, you know, the the frequency that they that they go to see medical providers, and I would allow them to have choice, you know, with within kind of a confined list of specialists that, you know, understand the workers compensation rules and regulations so that, you know, we don't have medical providers treating folks for conditions which, you know, are not their specialty. But on the converse side, would give, you know, the employers a little bit more freedom about who they can return to work, when they can return them to work, so that it's sort of fits with their business model. So maybe a little bit more given take on both sides. And then, you know, from an insurance employee perspective, let's add that third leg to the stool, you know, the claims adjuster or the nurse case manager, you know, trying to help the injured party, allow them to have a little bit more flexibility and how they contact and interact with the injured party. You know, maybe almost in a sense, let the injured party control that if they want to, you know, strictly communicate electronically if they want to strictly communicate, you know, be via phone. What's...

...what's comfortable for them. You know, maybe provide an avenue for them to be able to get questions, you know, answered quickly, you know, kind of almost a chat bought format, you know, so that they have some security and and, you know, no kind of what the next steps are in the process if they're unclear. So that's that's kind of my blue sky vision. Yeah, I mean meeting them where they are. Yeah, point in time. Do what about wellness well being? Do you see any do you see a place for that within an advocace model where you're either folding in access to potentially therapists or to physical health or to maybe things that are outside of your immediate injury or but are related to kind of the whole with the person? Sure you know there's there's obvio in the industry there's been a lot of discussion about treating the whole injured employee or injured work or in the workers compensation system and I think honestly we all, all stakeholders to the process, have gotten better in terms of recognizing that and you know, maybe there is a place for a social work component. You know, in a sense can we have whatever is going on in the personal life of that injured party, whether it's familial or them individually. There's no question about it that that impacts the rate at which they can heal and the rate at which they can get back to work. So recognizing that wellness component and that, you know, it's not always necessarily probably part of the workers compensation process, but it almost acts in in a parallel sense, you know, as an additional benefit and employers that realize kind of those two different tracks and, you know, offering that wellness component. I it's only going to improve the over all results on the workers compensation claim. It's going to improve, you know, the employers productivity and the contribution that they can make, you know, to the employers world, and I just it's a win win on both sides. We don't see it, though, as often, I don't think, yet in the industry, and that that's certainly probably an opportunity for everyone to kind of keep striving towards and and, you know, aiming for as an industry goal. Absolutely, so slight pivot, but for I find a question for sure, but I think it's relative it's relevant when you you know, hopefully we're coming to the tail end of this pandemic. I know we've been said before, and then we find ourselves back in a simlar situation. But when you either look back at what has been the you know, the the kind of the most difficult parts of the pandemic, or even future state where the pandemic has maybe changed how we operate, do you think that we need to rethink any part of advocacy or at do you think that it's really kind of perfect,...

...given the the change of environment and the scenarios that were under that it's perfectly in line. Yeah, so a couple of points there. You know, certainly the world has become much more comfortable interacting electronically and you know, the the telemedicine concept was, you know, is was not new. That was certainly a pre pandemic reality, you know, and in the insurance process and feels like that's had an opportunity to take hold and we've become clear as an industry where that's going to be effective and maybe where it's not going to be so effective. So you know, kind of continuing with the momentum there and you know that becomes rather than just kind of a side process or, you know, a novelty, you know, way to obtain treatment, it becomes, you know, again, a realistic path and, you know, part of the resources and benefits that are available. And then when I also, you know, look at the pandemic on the other side of it. So you know and we've embraced, you know, technology and, you know, interacting virtually, but at the same time I think we've also appreciated that there definitely is up time and a place and it matters, you know, for human interaction and you know, when you're looking at that whole body approach to treating a worker's compensation claim, I don't think we can get away from the importance of interacting with, you know, a medical professional, social worker, a psychiatrist or psychologist to help, you know, heal and to help further that process to you know, getting back to a new normal or what the normal is going to be for that injured worker. So it's almost like the line have become less blurred. We have to have a balance and so, you know, kind of approaching the process through, you know, we're meeting with a medical professional or mental health professional, is going to is going to be helpful and it could be on a case by case or a claim by claim basis or where the virtual option is, you know, is going to be a good option too. So I think the pandemic has helped us better define that and that's positive for the industry. Yeah, I completely agree, and I mean even a personal lives. You know, I think there was a there was an appreciation for the ability to operate virtually the to accelerate, to your point, things that were existed but we're necessarily accepted as either the norm or a realistic path way for an individual, teleibatison being one of them. And then there is also a reality check, you know, definitely under several months where even just your own personal health insanity, we found yourselves needing to interact with human beings a more tangible way. I mean that I'm...

...an introvert, yeah, but I need that human connection and I saw it in my children as well, and not related to a worker. Is kind of claim, but you can see in their ability to socialize that it's had a direct impact on their mental health. And I think we can make the same case, and I know we can. Have Been Studies has been validated at a you know at an individual you know, employee employer level. So it will be interesting that balance he talked about, to see what the future holds for us. I agree. Thank you for that inside Great Chrisia. Thank you so much for your time today. You know, there we may have some folks that want to reach out to you for some insights on your position with advocacy. I know you have, by speaking, engagements from time to time. I'm sure there would be some interest there as well. What's the best way to get a hold of you? Linkedin email? What do you recommend Linkedin? Absolutely all right, all right, folks will try. Let's see you go. Thank you so much for your time. Look forward to the continuing partnership between brass virus CNA and hopefully we'll talk again in the future. Thank you, mark. It's been a pleasure you've been listening to be on the claim a podcast for risk and claims leaders. To ensure you never miss an episode, please subscribe to the show in your favorite podcast player, if you use apple podcast. We'd love for you to give us a quick rating for the show. Just tap the number of stars that you think the podcast deserves. Until next time, stay curious and keep innovating,.

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