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Psychosocial factors weigh on comp claims

Posted On: May. 1, 2017 12:00 AM CST

Psychosocial factors weigh on comp claims

Mounting evidence demonstrates that some troublesome workers compensation claims have more to do with the mental aspect of being injured than the injury itself.

Trecia Sigle, Columbus, Ohio-based associate vice president of worker comp claims for Nationwide Insurance, said the industry is ripe for change.

“It used to be from an insurance perspective, we never thought about (psychosocial issues),” she said. “I don’t think that they saw the value in it … We as an industry didn’t understand the impact of the bio-psychosocial problem when we were looking at a claim.”

Ms. Sigle and others credit recent studies that point to psychosocial issues such as depression and anxiety that arise with an injury as a major driver when it comes to an insurer’s inability to close a claim.

One study released in late March found that claims leaders ranked psychosocial issues as the No. 1 barrier to successful claim outcomes, according to Chicago-based managed care solutions provider Rising Medical Solutions’ 2016 Workers Compensation Benchmarking Study.

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

According to the Rising report, the “greatest roadblock to timely work injury recovery and controlling claim costs … is the negative impact of personal expectations, behaviors and predicaments that can come with the injured worker

or can grow out of a work injury.” The report also highlights how many claims professionals surveyed have skills in customer service and communications, and possess traits such as empathy.

The Rising study follows other recent studies such as one conducted by Hartford Financial Services Group Inc., which in 2016 analyzed its workers comp claim data from 2002 to 2015 to find that 10% of them featured at least one psychosocial issue and that those claims accounted for 60% of claims costs. In another study, conducted by Lockton Cos. L.L.C. in 2016, 39% of claims had derivatives of the word “fear” in claim adjusters’ notes — a study that revealed anxiety to be high among those injured on the job.

“I think that studies are better and medical literature is better,” said Ms. Sigle, whose company is now exploring what it can do to better serve injured workers to avoid problems later on.

“(It’s) a program that we are working on to revise claim-handling philosophy to a more advocacy-based approach,” she said. “We view this as a one of our biggest focus areas, especially with our older claims.”

One solution has been to provide cognitive behavioral therapy when a provider deems it necessary for an injured worker to heal, she said.

Nationwide isn’t the only company honing in on the psychosocial aspect of a claim. The Rising study named grocery store chain Albertsons Cos. Inc. as a leader in the field of tackling the issue. In the Rising study, Albertsons revealed that since 2013, roughly 9% of workers injured in the company’s stores who were voluntarily screened for mental complications were found to have psychosocial issues embedded in their workers comp claim.

Denise Algire, Pleasanton, California-based director of risk initiatives and national medical director for Albertsons Cos., said the company saw psychosocial issues in workers comp as a major driver for long-tail claims — in line with what claims handlers revealed in the Rising survey.

“(The issues can) drive up claim costs far more than catastrophic injuries,” said Rising study 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.”

In 2013, Albertsons launched a pilot program in several of its 40 markets that provided injured workers the opportunity to consult with a third-party “health coach” whose primary job was to gauge the worker’s mental state in light of the injury, according to Ms. Algire, who called the program a success and a major driver for improved return-to-work figures. The company is now tallying its results, she said.

Ms. Fikes said Albertsons’ approach is good corporate strategy and that more companies should adopt a similar approach.

“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 toward advocacy-based claims models over adversarial, compliance and task-based processing styles,” Ms. Fikes said. “Simply put, advocacy models — which treat the worker as a whole person — are betterequipped to control or eliminate psychosocial factors during recovery.”