Q & A Table of Contents
Our Dispute Resolution Process Doesn't Work
From: Sonja, Bismarck, North Dakota
Question: We have a binding dispute resolution process that was created by legislation in an effort to have a third party independent set of eyes look at the facts. Hopefully this process would decrease litigation.
It turns out that those hired to perform the process have decided to "win" at all costs in an effort to look good to ensure the continuation of this program and their jobs. If this group's objectives to reach settlements are not met 100%, they have done underhanded things like telling the person they represent what to tell their physician to say in order to get their claim covered for life. They have even gone as far as tell them what physicians to use.
This underhandedness and dishonesty has caused much dislike and friction between those who handle the claims honestly and the dispute resolution group. They hate each other. It's getting worse. What do you suggest?
Response: The system's failure needs to be examined from two different angles. While there certainly must be a study of the design faults, the more pressing need is a review of the people/organizations certified to undertake dispute resolution for your agency.
In your question I could not figure out whether the 'dispute resolvers' are part of an independent organization, are individual private contractors, or are somehow attached to one side or another of the workforce safety "business" as overseen by your agency. Are the dispute resolvers members of a trade association? Are they lawyers, social workers, or members of another specific profession?
It sounds as if your agency's first step should be to find ways to limit the number of claims each dispute resolver is assigned in a given year. Moreover, perhaps there should be term limits for the certification - so that no one can make it his/her long-term profession. The question is whether your organization, as a State agency, has the power to improve the governance of the process by yourselves or whether you are dependent on the State Legislature for any changes.
The dispute resolvers with whom you are burdened are not bringing credibility to the process. If your allegations are accurate, they are turning both physicians and claimants into liars, or at least dealing in what lawyers call "forum-shopping".
One other thing I can't figure out from your question is whether your agency is the only aggrieved party, or whether employers, health care organizations, or private insurers are also troubled by the current situation. If there are others who share your pain, you should develop a coalition to focus on questions of improving things, and how to get those improvements enacted.
Good luck with this,
Steve
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