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Communication plans, technology deployed to steer workers through claims process

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The so-called advocacy approach to workers compensation claims has gained ground over the past year as injured workers faced anxiety and uncertainty due to delayed medical care and a greater reliance on technology during the COVID-19 pandemic, experts say. 

Workers have needed more help steering through the claims process, including using technology to access remote health care, and the extra stresses endured have highlighted the importance of behavioral health services, they say. 

“Advocacy is really about helping the injured worker navigate the workers compensation landscape and their medical care. … Over the last year that need has only increased,” said Mike Hessling, Rollings Meadows, Illinois-based CEO North America of Gallagher Bassett Services Inc. 

The advocacy approach in workers compensation has been a trend in recent years as the industry has strived to avoid adversarial issues that could lead to complications with claims and possible litigation. Essentially, the approach has called for improved communications with injured workers and coordination of care. 

Liberty Mutual Insurance Co. has put more emphasis on the advocacy approach, said Patrick Hiles, St. Louis-based vice president and manager of the south region for workers compensation for the insurer. “It’s making sure they understand the process … and making sure we address their concerns and questions. Staying away from jargon.” 

Social isolation during shutdowns has added to the stress of injured workers and led to more anxiety, said Tammy Bradly, Birmingham, Alabama-based vice president, clinical product development at Genex | Coventry, part of Mitchell International Inc.

A greater focus on advocacy has been part of the “dramatic change in the way some of the claims are being managed over the past year with the onset of the global pandemic,” Ms. Bradly said.

Newly emerging processes and communications protocols are also being used, she said. 

Most large workers compensation insurers and third-party administrators now offer workers access to a smart phone or tablet application that simplifies filling out forms and other processes. And injured worker interest in on-demand access to claim information has increased during the pandemic, experts say. 

At the onset of the pandemic “we saw a greater influx in the use of self-service technology,” said Max Koonce, Fayetteville, Arkansas-based chief claims officer at Sedgwick Claims Management Services Inc., whose application MySedgwick has become an integral part of the TPA’s claims-management communications. Improved communications lead to “better relationship building, working through the dynamics of a claim,” he said. 

The pandemic also brought an explosion in the use of telemedicine technology. 

Once slow to catch on in the workers comp sector, telemedicine helped workers access care, with some third-party administrators and providers reporting exponential growth in services that use technology to connect providers with patients to manage treatment. 

“The pandemic certainly drove greater adoption (of telemedicine) than we have ever seen in any point in comp,” Mr.
Hessling said. 

Claims handlers had to rethink how they did their job and how to help injured workers become comfortable with technology that enabled continuance of care, Ms. Bradly said. 

Telemedicine also helped claims managers manage surgery and other treatment delays that became common in the pandemic, providing an extended period prior to surgery to intervene and support patients, she said. 

“Prehab gets them in a better position, so when they do have that surgery, rehab will be much shorter because of what they did beforehand,” Ms. Bradly said, adding that greater reliance on technology kept workers connected while they waited on
surgery delays. 

A year into the pandemic, a hybrid approach has developed with coordinated telemedicine and in-person care. The model has improved communication with injured workers and led to greater attention to mental health, which is an issue the workers comp industry once avoided, experts say.

Joe Paduda, Skaneateles, New York-based principal of comp consulting firm Health Strategy Associates LLC, said greater attention to behavioral health has become crucial and is growing. 

“What happened in the industry is they didn’t want to take on psych treatment when really anybody with an injury has some behavioral element attached to it,” he said, adding that the industry still has work to do in accepting mental injury aspects of claims, which have typically been separated from the claim and deemed not compensable. 

Behavioral health is something that is becoming more of a concern in workers comp, Mr. Koonce said. 

“To get the best results, you have to treat the whole person; that includes mental, emotional and physical. If we improve communication and advocacy, we will continue to bring in the entire person into the recovery process,” he said.









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