State of Denial and the Shots Heard Round the Insurance World

In a tragic incident this week, UnitedHealthcare CEO Brian Thompson was gunned down while entering a hotel for an investor’s conference in New York City. While (as of this writing) the suspect has not yet been apprehended and the motive remains unknown, undoubtedly, many in this country, myself included, reached an immediate conclusion.

Disgruntled policyholder.  Or someone otherwise who felt severely affected by a denied or delayed health care claim.

Some evidence that has emerged has supported that assumption. Shell casings left at the scene of the shooting had the words “deny,” “depose,” and “defend” written on them. It is clear this was a targeted attack, and many of us will not be surprised if our initial assumptions are proven correct. And if that is the case, this event likely will have caused concern throughout executive levels of the workers’ compensation industry.

It is a fact that claims get denied in insurance. Many of those denials are justified. Some of them are not. While the latter is a more significant concern, how all denials are performed likely needs more scrutiny. The fact remains that, justified or not, a denial of a health care or workers’ compensation claim can have an enormous emotional impact on the recipient of that decision. In a day and age where tolerances are short, and people seem to be lashing out more, this is an issue that should get our attention.

Many of us have had negative experiences when dealing with insurance companies. I am personally in a developing dispute with a property insurer over damages to my home from Hurricane Milton. Many years ago, my wife and I had a rage-inducing experience over a denied medical claim. That experience was mostly resolved, but only after months of delay and the assistance of an attorney. We were never entirely “made whole” from the experience. While this loon’s actions in New York can never be justified, we can understand the underlying emotions that might have motivated him to take such a senseless and tragic action.

The point is that even legitimate denials can stoke anger and irrational behavior. People get upset when their expectations are unmet, even if they are not rational or justified. How we handle those rejections can make a difference and is something our industry should look at. 

WorkCompCollege.com has produced a course on this very topic. “How to Say ‘No’” is a comprehensive presentation given by Todd Holt, Deputy Executive Director of the Texas State Office of Risk Management (SORM). In the course Mr. Holt emphasizes empathy in the communication process of issuing denials while also giving insight into the balance of power between the parties. He stresses the finer points of communication and provides suggestions for handling difficult conversations. It is a topic that has not traditionally been part of training in our industry.

But recent events may be a reminder that it is an issue we ignore at our own peril. 

The denial notifications that I have seen (and in one case, personally received) have been cold, technical, and highly impersonal. There is generally no acknowledgment of the impact that decision may have on a person or family in the process. While there are certainly legal considerations that affect what may be said in the process, finding a way to treat the recipient with respect and empathy when delivering the message could go a long way toward mitigating hostility. 

How we treat people matters – even if they are in the wrong. Being aware of the impact of our decisions is critical. While much remains to be learned about the unfortunate death of Mr. Thompson, we should never be in denial over the importance of a proper and empathetic denial.