Workers’ compensation programs consist of a complex web of claims, numbers, analyses, and communications that require an inordinate amount of time and focus from claims adjusters and claimants alike. And with 2.8 million nonfatal workplace injuries and illnesses reported by private industry employers in 2017 alone, according to the U.S. Bureau of Labor Statistics, this complicated process is widespread.
Furthermore, claims themselves are growing more complex. A survey conducted at the 2018 NWCDC & Expo by Risk & Insurance revealed an increase in complex claims as among the top 10 workers’ comp challenges for 2019. Dr. Robert Goldberg, chief medical officer for Healthesystems, told Risk & Insurance, “Many complex claims develop due to the psychological aspects of the injured worker that either pre-date the injury or are caused directly or indirectly by the injury. Early identification and intervention are required to short-circuit the development of such claims.”
With the right technology in place, companies and their employees can simplify and streamline the workers’ comp process. This reduces claim complexity, protects injured workers, and returns business to usual more quickly.
1. Mobile apps and online portals
Today’s consumers have high expectations for their service experiences. Claimants do, too. According to the Risk & Insurance article 10 more workers’ comp issues to watch in 2019, “Customers expect their customer experience to be completely personalized in today’s economy. Poor customer service impacts where one spots and the perception of a brand, but also whether one engages with the brand, whether one goes back, and other considerations. [Sedgwick’s chief healthcare officer Kimberly] George says the same is true in workers’ comp. ‘We believe emphasis on the consumer experience is paramount to success.’”
Origami’s Mobile Claimant app helps deliver this type of personalized service to claimants while also increasing the efficiency of adjusters. Without the need for internal staff to drop what they’re doing and accommodate requests for claim information, claimants can review the status of their claim and payments on their own schedule.
In addition to the mobile app, Origami’s online portals can be used to improve claimant satisfaction. As discussed in Using technology to increase client engagement, online portals “give clients the tailored, 24/7 access to critical information they demand… Since these portals can be easily configured to meet the informational demands of individual clients without requiring IT resources or product development requests, they can continually adapt as needs evolve.” This self-service option helps increase claimant engagement through greater accessibility, as well as straightforward instructions for entering incident-related details and uploading supporting documents.
Claims adjusters also benefit from online portals, as they help take care of repetitive, time-consuming administrative tasks and eliminate the need for following up with injured employees and medical providers. With this additional time, adjusters can focus on claimants’ individual circumstances and needs, delivering the personal focus claimants seek and deserve.
2. Integrated disability and treatment guidelines
Origami Risk is integrated with the Official Disability Guidelines (ODG), a product of the Work Loss Data Institute. The ODG integration provides access to evidence-based medicine (EBM) data, including more than 10 million cases and decades of research by a team of physicians, nurses, methodologists, and external reviewers who value data-driven science.
The ODG integration allows adjusters to enter, track, and act on claims in real time. Data such as primary and secondary diagnoses, a target return-to-work date, and a Risk Assessment Score (RAS), allows adjusters to monitor the highest-risk claims and intervene early—precisely what CMO Dr. Goldberg cited as the key to preventing complex claims.
The integration can trigger alerts so adjusters know how quickly to act. These alerts keep all stakeholders aware of changes and guideline updates, preventing miscommunication and unnecessary delays. As noted in TPAs – Supercharging your claims handling, “Rising Medical Solution’s 2016 Workers’ Compensation Benchmarking Study found that users of EBM data were more than 4X more likely to be top performers than those who did not.”
Most importantly, Origami’s ODG integration contributes to the health and wellbeing of claimants. The integration allows companies to view trends and opportunities, including quicker return-to-work times. The guidelines also provide recommended courses of action for an injury or illness based on specific data provided. This comprises EBM procedures (including physical therapy guidelines) and acceptable activities once the claimant returns to work. Each recommendation links to corresponding literature for further reading, so both claimant and adjuster can be sure they’re taking the most seamless approach to recovery and reentry into the job.
Return-to-work programs can reap many benefits from interactive, organized dashboards. Origami’s dashboard solution simplifies the management of claims and claim-related tasks. Claims adjusters can set up multiple dashboards based on location or specific area of focus (cause of injury, injury type, injury severity, etc.). They can then share their dashboards with different stakeholders based on role-specific levels of involvement. For example, claim supervisors may have access to adjusters’ dashboards to help address critical issues or give approval where necessary. Those who don’t need access to the finer details may only receive permissions on higher-level widgets that inform company-wide trends.
Origami’s dashboard functionality also includes report lag analysis. Using this feature, adjusters can set time-based parameters (3, 7, 14, 30, and 90 days, for example) that makes it simpler to spot outlying claims. This automated exception-based incident reporting not only saves time, but also ensures that claimants with the most severe or complex cases receive the immediate and extra focus they need.
Dashboards keep claims and claims data organized, on track, and easy to analyze. Claims move through the process as expected, adjusters stay accountable for next steps, and claimants benefit from a streamlined, reliable process that will move them toward a speedier recovery and faster return to work.
Bolster your worker’s comp program with a RMIS like Origami Risk. The platform includes the above functionalities that more seamlessly collect information from employees, monitor claims progress, and return employees to work faster.
Schedule a demo to see how Origami’s workers’ comp functionalities can strengthen your return-to-work program.