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Data enables claims handlers to target mental intervention


A 62-year-old truck driver slipped and fell at a rest time while getting gas, injuring his back again in a string of back injuries and is told, years into conservative treatment, that surgery may be the only cure for his chronic pain.

A 50-year-old warehouse worker falls backward after tripping on a pallet, injuring her arm, wrist and shoulder — a soft tissue injury that carries all the signatures of becoming chronic.

While the injuries are physical, a Monday session during the Risk & Insurance Management Society Inc.’s 2021 online conference showed how a combination of artificial intelligence, data analytics and telemedicine services helped these real-life cases come to closure by deploying cognitive behavioral therapy.

Essentially, it’s getting the workers to rethink their injury and outlook, according to presenter Stacey Caldwell, a corporate claims manager for workers compensation services provider Barrett Business Services Inc.

In the truck driver’s case, it was “to talk to him about coping skills and how he thought about his pain, and really focus him on what he could do,” she said. It led to weight loss, she added, and eventually improved health and function — all without surgery.

The last case, the woman with the shoulder injury, had been pegged for “catastrophic thinking,” Ms. Caldwell said. She “had really gone down the rabbit hole, (saying) ‘I will never be able to work again.”

Without tackling the mental component, the claims would have lingered, by at least five years in the last case, she said.

It’s where data analytics has been instrumental, said presenter David Lupinsky, vice president of digital health and innovation for CorVel Corp., which provides data services for the comp industry.

By discovering more about individual claims, and comparing them to data stores on similar claims, managers are able to tackle some of the issues that cause claims to stall, he said. Analyzing claims includes looking at a person’s medication history, their lifestyle, past injuries, and more. For many claims, it is found that the hurdles to recovery are more mental, and include catastrophizing, perceived injustice, fear avoidance, distorted beliefs, he said.

With delayed recovery and pain management the biggest drivers of costs in workers comp, Mr. Lupinsky said data helps identify risk and push out treatment “that we don’t have enough of. That’s where we wanted to go.”

Telemedicine — increasing steadily since the start of the COVID-19 pandemic — has opened more doors to offering cognitive behavioral therapy, he said.

“With the ability to telehealth, we are able to take specific providers with specific skill sets or who can speak a specific language and take these teams and move them across large geographic areas… and return to function this population,” he said.







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