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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“A workers’ compensation adjuster is not a paper pusher.” That’s one of “60 Tips for Superior Claims Handling” issued as part of a panel discussion held at a past National Workers’ Compensation & Disability Conference. “Work comp claims are more difficult than general liability claims. If you think of them as a paper pusher, that’s the output you’ll receive.”
Numerous articles make clear the impact of adjusters’ experience, skills, and judgment on claims outcomes (For example, see “Good Adjusters Know When to Settle Your Workers Comp Claims.”) Nonetheless, as indicated by the fact that panelists felt it necessary to make the point that adjusters are far more than back-office clerks, the misperception persists.
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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 Add outdated claims management software, disparate systems, and manual or paper-based processes to the mix and productivity can suffer.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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A good workers’ comp claim adjuster is a master of coordination. Managing 100-125 open claims certainly stands as proof. Yet, caseloads alone hardly tell the complete story.
For newly assigned claims, information must be collected from the employee, employer, and medical provider. Reserves must be established and reviewed for accuracy. There’s regular follow up with claimants, nurse case managers, attorneys, and other stakeholders. Compensability reviews. Evaluation of settlement opportunities. Mediations to attend. And that only begins to scratch the surface.
Yet according to the Accenture white paper “Claims at a Crossroads,” claims professionals can “spend nearly half their day on activities that do not impact the outcome of the claim.” While those administrative activities may be necessary components of the process, that time is better spent engaged in activities—such as those cited above—that fully leverage the adjuster’s talent and experience, keep claims moving on the path toward successful resolution, and increase the likelihood of outcomes that benefit both employee and employer.
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Experienced adjusters are typically experts when it comes to understanding the nuances of a particular jurisdiction’s (or multiple jurisdictions’) workers’ compensation indemnity benefit laws. This can contribute to an efficient claims adjudication process and accuracy when determining the indemnity benefits owed to an injured worker. Will experienced adjusters be able to keep up as your business expands into other jurisdictions? What about less experienced adjusters?
Add to this the fact that the common practice of using spreadsheets to calculate both average weekly wage (AWW) and indemnity benefits is both time-consuming and risky. Not only is it necessary to keep up with the changes jurisdictions make to rates and regulations, but given the complex formulas involved, errors can be easily introduced and quickly proliferate.
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The clock is always ticking on workers’ compensation claims. Delays at any point in the claim lifecycle can contribute to claims remaining open longer and compound their cost. Taking a close look at the procedures and best practices used by adjusters—to determine where the potential for delays can be significantly reduced, if not eliminated altogether—is essential to reducing the cost of claims and improving outcomes.
In a recent post, we looked at how the Origami Compliance Forms & Correspondence solution contributes to a more efficient and accurate approach to workers’ compensation reporting. Realizing improved efficiency and accuracy in the processing of state forms is a major step in the right direction. Answers to the following questions should also be factored in: … read more
In recent posts, we looked at the Origami Compliance forms solution contributes to a more efficient and accurate approach to workers’ compensation reporting. Given the fact that reporting workers’ compensation claims is a requirement that carries the threat of penalties and fines and security of systems and data is a growing concern, we’ve also addressed the importance of choosing a proven technology partner you can trust to provide claim reporting accurately and take the security of your data as serious as you do.
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“Protecting Data in Motion”, a March 2018 Risk & Insurance article, points to the fact that during the first half of 2017 alone, at least 2200 breaches—totaling over 6 billion records—were publicly disclosed. And those were the numbers prior to the reporting of the Equifax data breach.
As claims organizations improve operational efficiencies by using technology designed to eliminate paper-intensive, inefficient, and error-prone processes, it’s critical that the vendors they work with monitor and address security vulnerabilities. … read more
Public entity risk managers looking to further reduce the costs associated with workers’ compensation claims continue to recognize the value of a behavior-based risk and safety management model. According to Public Entity Risk Managers Speak Out: Results of the 2017 Public Entity Employee Safety & Loss Control Survey, “Now more than ever, the best strategy is to take a holistic approach to risk management to prevent claims from occurring in the first place with loss control strategies.”
The development and implementation of a pre-loss model that measurably drives accident reduction and workplace safety requires effective collaboration between risk management and safety teams. Transparency and the sharing of information is essential to success. Both can be severely restricted when using spreadsheets or outdated legacy software. … read more
A recently published, comprehensive workers’ compensation benchmarking study, found that claim costs make up around 80 percent of most claims organizations’ expenses. According to the study’s authors, budget reductions and heightened scrutiny of operational expenses that come as a result mean that claims organizations should “take a close look at what claim activities and best practices drive optimal outcomes.”
Ensuring that paper-intensive, inefficient, and error-prone processes are eliminated is critical. For many claims organizations, this means scrutinizing their workers’ compensation compliance and reporting processes. More specifically, it means finding a solution that reduces the amount of time adjusters spend:
- Tracking down the correct version of state forms
- Rekeying data previously entered in the claims management system into forms
- Correcting errors that result from manual entry of claim details
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