In this Briefing Note, we look at the many traps that can adversely affect a disability claims assessor’s decision-making process, and how they can be identified, recognised and ultimately avoided.
Efficient management of disability claim files that lead to fair, just outcomes for all parties is a key responsibility of every claims assessor.
Before making decisions, whether on disability income or total permanent disability claims, prudent claims assessors must evaluate each claim’s information fully and correctly. It can be all too easy to fall into well-worn patterns of investigation and analysis that have been successful in the past.
In this Briefing Note, we look at the many traps that can adversely affect a disability claims assessor’s decision-making process, and how they can be identified, recognized, and ultimately avoided. Familiar and oft-used patterns, no matter how effective, might not always be the best approach. Problems can occur at any time during the processing of a disability claim that can make the claim difficult to manage and delay the final decision. When a claims assessor’s personal beliefs and assumptions, and the influence they can have on the assessor’s claimant communications and interactions, are factored in, it is easy to see how decision-making traps can trip even the most conscientious assessor.
The 1998 Harvard Business Review article ’The Hidden Traps in Decision Making,’ by John S. Hammond, Ralph L. Keeney, and Howard Raiffa, states:
The article further suggests it is the `invisibility’ of these traps that make them dangerous … and because they are hardwired into our thinking process, we fail to recognize them – even as we fall right into them.
Decision-making traps are many. They include over-reliance on video surveillance, considering only paper-based evidence rather than the results of medical examinations, making assumptions about a claimant’s physical abilities and the physical requirements of his/her occupation without obtaining supporting information, and not providing full medical evidence when instructing the medical professionals who will be performing the examinations.
Here are four of the most frequently encountered decision-making traps.
The Anchoring Trap
What it is: When the mind gives disproportionate weight to the first information received, initial impressions, estimates, or data ‘anchor’ (or prejudice) subsequent thinking and judgments.
An example: A disability claims assessor might rely only on the initial medical information received to assess a claim, rather than communicating further with the claimant, the physician, and the employer to render a fuller evaluation. Only relying on initial information will unduly and wrongly influence the claim decision.
How to avoid:
The Status Quo Trap
What it is: We all have biases that influence our choices and are predisposed to perpetuating status quo choices. It’s inherent to human thinking – and it’s easier not to question or change.
An example: The (infamous) perpetual ’Attending Physician Statement (or General Practitioner Report) Cycle.’ The cycle is thus: Claim approved based on initial APS ~ request an updated APS in three months ~ review APS ~ continue benefits ~ request an updated APS in three months ~ review APS ~ continue benefits, and on and on.
How to avoid:
Maintain a proactive claim action plan that:
The Sunk Cost Trap
What it is: Almost everyone is biased in favor of defending and justifying flawed past choices. This bias usually emerges when we are unwilling, consciously or not, to admit a mistake.
An example: Although a claimant’s rehabilitation program has plateaued, the claims assessor or rehab specialist will approve continuation of the program in the hopes it will finally produce positive results.
How to avoid:
The Confirming Evidence Trap
What it is: Seeking information that supports one’s existing point of view, giving too much weight to the information supporting that view, and not paying enough attention to conflicting information.
An example: An assessor, needing an independent medical examination to strengthen his decision to decline a claim, will schedule the examination with a specialist/ expert who he knows will draw conclusions likely to support his position.
How to avoid:
The disability claims assessor's job is to make the right decision about the validity of every claim, based on all the evidence presented. In reaching these decisions, an assessor must have made a thorough analysis of all of the evidence.
At every stage of the decision-making process, misinterpretations, biases, personal beliefs, and unwillingness to change or modify our behaviors can influence the choices we make and trap us into poor case management practices. The best protection against these traps is awareness and a willingness to take action to avoid them. Don’t be afraid to take a step back, and think again …
