Printed from

Workers comp claims outcomes rely on key practices

Posted On: Nov. 16, 2016 2:30 PM CST

Workers comp claims outcomes rely on key practices

Getting injured employees back to work tops the list of practices that help lead to the best claims outcomes in workers compensation, yet only half of the claims organizations surveyed in 2016 apply them, according to a report released Wednesday. 

For the first time in its four years of surveys, The Workers’ Compensation Benchmarking Study identified precisely which claims best practices are generating better outcomes, according to Chicago-based Rising Medical Solutions, which specializes in medical bill review and medical cost containment.  

At the top of the four strategies listed is a focus on getting an injured employee back to work, or setting key performance indicators.

“Claims leaders indicate the most important claim outcome is for the injured worker to return to work at equal or better fitness than before the injury,” the study stated. “Claims organizations are prioritizing functional recovery as the main benchmark for claims success. High performing claims organizations are more likely to use (key performance indicators) that clearly show how desired claim outcomes are being achieved or not achieved.” 

Other strategies listed include: employing claim decision-support tools, with 66% of organizations utilizing workflow automation and 50% using push technology or predictive modeling; utilizing an employee-centric claims service model, or an “advocacy-based claims model; and innovating and being early adopters, “implementing value-based care models, linking provider quality and outcome measures to provider agreements, and employing formal knowledge transfer strategies.”

For 2016 researchers also examined the greatest obstacles in achieving claim outcomes, with comorbidities, lack of an accommodation or return to work option, litigation, and employer/employee relationship as the top challenges, according to the report.  

For the 2016 study, researchers surveyed 492 claims leaders nationwide to pinpoint which methods have driven success in their organizations.

Since 2013, the Workers’ Compensation Benchmarking Study has surveyed nearly 1,200 claims leaders about their biggest operational priorities, challenges and opportunities, as well as their strategies for improving claim outcomes, according to the report.