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November 12, 2001-9:45 p.m. Today in Sa-land�a little about my job. I may have mentioned that I work for an insurance company. My actual job is processing health care claims, specifically those related to physical therapy and chiropractic services. The account that I work on has a supplemental accident benefit. Basically this means that if you seek treatment for an injury related to an accident within twenty-four hours of the accident, the plan pays the first $250 in related charges at 100%. When a claim is received that the system deems to be potentially accident related, a form letter goes out asking whether the claim was the result of an accident and if so, on what date the accident occurred. As you can probably imagine, this letter serves to infuriate many of the claimants, as they mistakenly believe we are asking about a job-related accident or perhaps an auto accident. In the course of my job, I may receive as many as thirty of these completed letters in a day. Normally they say something to the effect of, �No Accident.� Or �Fell off of bike June 3, 2001.� Occasionally, they say, �Stop employing these delay tactics in an effort to avoid paying my claim. I�ve seen the Rainmaker.� which we then interpret to mean, �No Accident.� Today in the mail, I received a three-page reply to the accident information request. The woman in question, a sixty-something retiree, fell while bowling on July 10, 2001. That�s really all of the information we required to process her claim accordingly. She saw fit to provide all sorts of extraneous details including at what point during her approach to the lane she fell, the posture of her body at the time of the fall, the name and address of the bowling alley including phone number and area code, her various activities in the days subsequent to the injury and so on, ad infinitum. I picture her composing this missive with no doubt whatsoever that we employ all sorts of fact checkers who will pore over her claim, calling the bowling alley and Jennie who works there and with whom she filed an accident report, to verify the facts. Perhaps we will even contract Jane E Doe*, physical therapist, at 325 West Pine Street and inquire as to whether or not there was indeed an unavoidable delay in beginning to treat this patient. We may even be tempted to contact Dr Smith* and request medical records. In fact, what happens is that someone dutifully records whether it was an accident, if so the date of the accident and processes the claims accordingly. The document she so scrupulously labored over is then thrown away. This concludes this episode of the Sa-land Inner Workings of the Insurance Company Anecdote™. *Not their real names. **Disclaimer: All characters in this diary are fictional. Any resemblance to actual people living or dead, real or imagined, is purely coincidental and unintentional.** |
