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Psychosocial issues No. 1 barrier to successful comp claims outcomes


Issues such as emotional distress and fear were highlighted as the top barrier to closing workers compensation claims, according to a study released Thursday. 

Claims leaders rank psychosocial issues as the No. 1 barrier to successful claim outcomes, above lack of accommodation for return to work, litigation, strained employee/employer relationship, and late reporting of injury, according to Chicago-based managed care solutions provider Rising Medical Solutions’ 2016 Workers’ Compensation Benchmarking Study survey of 492 claims professionals. 

Out of that survey came the report, “How to Overcome Psychosocial Roadblocks: Claims Advocacy’s Biggest Opportunity,” which examines key best practices for addressing psychosocial factors.

“We know the single greatest roadblock to timely work injury recovery and controlling claim costs. And it’s not overpriced care, or doubtful medical provider quality, or even litigation. It is the negative impact of personal expectations, behaviors, and predicaments that can come with the injured worker or can grow out of work injury,” states the report.
“(The issues can) drive up claim costs far more than catastrophic injuries,” said co-author and study program director Rachel Fikes, in a statement. “Through this examination, one can see how adversarial, compliance, and task-driven claim styles are ill-suited for addressing the fears, beliefs, and perceptions of this distressed population.”

Researchers highlighted worker advocacy, or treating the injured worker “as a whole person” and proactively resolving nonmedical barriers to timely recovery, as among the top best practices. The study also found that greater training for claims adjusters in communication and soft skills, like empathy, is associated with better outcomes.

“It’s likely no coincidence that while the industry has progressively paid more attention to psychosocial issues this past decade, there’s also been a shift towards advocacy-based claims models over adversarial, compliance, and task-based processing styles,” Ms. Fikes said in a statement. “Simply put, advocacy models — which treat the worker as a whole person — are better equipped to control or eliminate psychosocial factors during recovery.”