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.
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This post was originally published on Risk Management Monitor.
Regardless of whether or not their organizations operate in states where the use of Official Disability Guidelines (ODG) has been adopted/mandated, risk managers can often leverage ODG data and the claim data from their risk management information systems (RMIS) to benchmark the medical and lost-time components of their workers compensation costs against national averages.
With its origins dating to 1995, ODG (www.mcg.com/odg) provides “unbiased, evidence-based guidelines” and analytical tools designed to “improve and benchmark return-to-work performance, facilitate quality care while limiting inappropriate utilization, assess claim risk for interventional triage, and set reserves based on industry data.”
The following are some ways risk managers can use ODG data in conjunction with their existing risk information tools to drive improvements in their workers compensation case management and achieve greater precision in loss reserve practices.
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Searching for a critical email, multiple browser windows open, bills to review, reports to write, lawyer and medical professional consultations, voice messages that came in while on other calls. It’s all part of the daily routine for claims adjusters. Add outdated claims management software, disparate systems, and manual or paper-based processes to the mix and productivity can suffer. The work backs up. In some cases, the potential for burnout is all too real.
“Adjusters normally deal with a high volume of cases, and each case can be emotionally draining,” writes Katie Dwyer in the January 2018 Risk & Insurance article Improving the Claims Experience. “The customer on the other side is, after all, dealing with a loss and struggling to return to business as usual.”
“At some TPAs,” adds Dwyer, “adjuster turnover can exceed 25%.”
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TPAs continue to face increasing pressure to find more innovative ways to drive efficiency and do more with less. An article in Lexology states, “Automated claim processing is the future for insurance carriers, third-party administrators (TPA’s) and large employers, to improve efficiency and reduce the resources required to process claims.” Determining a strategy for automating claims handling can be challenging.
A recent post examined the ways top performers approached automation. One key benchmark study of differentiators recommended: “Employ claims decision support tools – such as workflow automation, advanced analytics, and predictive modeling – and use them more frequently throughout the claim lifecycle.” In fact, top performers are 4X more likely to use automation throughout the cycle than all others.
To achieve the results similar to those of top producers, a comprehensive approach to improvements through technology must be employed. … read more
A recent article, “Transforming into an analytics-driven carrier“, examines best practices in what is a multi-stage journey that requires equal parts business and analytics leadership. The end goal is an organization where:
- Data-driven decision making is the standard
- Analytics is central to claims adjustment, underwriting, and pricing processes
- Analytics drive the entire business, functions are better integrated, and organizational silos no longer exist
The transformation is also dependent on having the right technology in place in order to begin to get buy-in and build momentum as a strategic vision for the organization is implemented. As a McKinsey Quarterly article puts it, companies must begin to build a foundation which enables change. “People have been talking about data-driven cultures for a long time, but what it takes to create one is changing as a result of the new tools available. Companies have a wider set of options to spur analytics engagement among critical employees.” For carriers still looking to move off of core legacy systems that struggle with modern requirements, even starting down the path to becoming an analytics-based insurer may seem out of reach. … read more
A major 2016 Workers’ Compensation benchmark study found that one of the largest differentiators of high-performers versus all other groups was the use of Evidence Based Medicine (EBM) guidelines. Users of EBM data were more than 4X more likely to be top performers than those who did not. The same study included a survey asking “What are the greatest obstacles to achieving desired claim outcomes?” Respondents ranked “Psychosocial/comorbidities” as the number one issue. … read more