Insurance Workers Get Advocacy Lesson : Government: San Diego consumer group holds seminars to instruct consumer division employees on ways to better aid dissatisfied customers.

Even dedicated members of the Department of Insurance’s Consumer Services Division acknowledge that their photographs might well be included in the dictionary definition of “bureaucracy.”

As the division’s name suggests, the Consumer Services Division is supposed to help consumers who believe that they have a legitimate gripe against an insurance company. But members of the division acknowledge that, too often, they feel ill-equipped to help consumers who are going up against powerful car, auto, life and medical insurance companies.

For starters, case workers complain that they are being overwhelmed by the weekly avalanche of telephone calls and letters that generate hundreds of new cases. Regulatory red tape often dictates how much--or how little--help they can devote to consumers’ problems. And, too often, some department members complain, top department officials seem beholden to the insurance industry they’re supposed to be regulating.

When those barriers stall the division’s ability to help consumers, staffers said, some members of the public assume that the insurance department is in cahoots with the insurance industry.

But help is on the way for the Consumer Services Division and--more important--for the public that it serves.

Department of Insurance Commissioner John Garamendi recently hired Utility Consumers Action Network, a San Diego-based consumer group, to teach employees and supervisors to think and act like consumer advocates. All training sessions are being held in Los Angeles.

“These people are acutely aware of their limitations,” said UCAN Executive Director Michael Shames, who is conducting the one- and two-day training seminars for division staffers and managers. “What we’re trying to do is help them break free of those constraints. . . . What we’re trying to do is change their mind-set.”

That mind-set is evident at the start of each seminar, when Shames opens the session by asking employees if they really want to be there. Invariably, the answer is a resounding “no,” Shames said. When he asks how soon they want to get out, the answer is “the sooner the better.”

That reticence is understandable, Shames said.

“These people are tired, and they’re feeling helpless,” Shames said. “For too long they’ve had people telling them what they can’t do.”

Tom Epstein, the department’s Deputy Commission for Consumer Protection, authorized the training seminars because most of the department’s employees transferred to the regulatory agency directly from the insurance industry. Although staffers’ previous experience in the insurance industry leaves them with a good grasp on the arcane world of insurance reg ulations, few have been trained in consumer advocacy, Epstein said.

But, according to Epstein, if public requests for assistance are a true indicator, what California’s consumers want is a strong sense of advocacy among the department’s staff.

The division’s 40-person telephone hot-line staff handled 600,000 calls last year from consumers seeking information. Seventy caseworkers handled 40,000 written complaints during 1991, and each caseworker now handles an average of 200 active cases, Epstein said.

“We think our staff is genuinely trying to do the right thing . . . but we thought (training) would help them to do their job better,” Epstein said. “We want to expose people who maybe hadn’t been trained . . . to the tactics and values of full-time professional consumer advocates.”

One staffer at a recent seminar acknowledged that many consumers feel that the department is run by administrators who are closely tied to the insurance industry. “I can’t blame them,” the staffer said. “The regulations don’t let us do things we want to do” to help consumers.

Shames doesn’t advise insurance department employees to break regulations. He instead pushes them to reach out to consumer groups, the media, other state agencies and the wealth of organizations that provide services--often at no cost--to consumers.

During seminars, employees use play-acting, case studies and group critiques to learn how to better serve the public. During one exercise, participants were asked to describe their “most rewarded experience as a consumer advocate.”

Staffers responded with examples of cases where they’d worked within insurance department regulations to help solve problems. One woman told how she’d spotted and corrected an insurance company error on a consumer’s application form; another told how she corrected an administrative error in another state agency and enabled a consumer to get an automobile insurance policy reinstated.

During subsequent group critiques, Shames applauded case workers for their work; but he also picked the cases apart, explaining how outside agencies or consumer groups might have prompted even better results.

Robert C. Fellmeth, director of the Center for Public Interest Law at the University of San Diego described the seminars as a first step in a top-to-bottom restructuring of the insurance department.

“These people are steeped in a subculture of passivity,” said Fellmeth, who speaks during the two-day seminars. “They are taught (by the system) to solve problems by jawboning.”

Jawboning, which Fellmeth described as talking to consumers and intervening with insurance companies on individual cases, “might solve one or two out of 10 complaints, it doesn’t do anything for the others . . . and it actually ends up institutionalizing the bureaucracy.”

Fellmeth suggested that the insurance department create a consumer information bank akin to one that the state bar created in 1991.