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Improved comp claims management hinges on mental, social elements

Posted On: Aug. 29, 2022 12:21 PM CST


Tackling societal health disparities and training frontline staff on psychological issues are among the areas where the workers compensation industry can improve, according to a study released Monday that examined hurdles in getting better care and recovery for injured workers.

Conducted last year by Chicago-based managed care solutions provider Rising Medical Solutions over a series of focus groups among employers, insurers, state funds and third-party administrators, the study aimed to examine “real-world strategies organizations are using to overcome the foremost barriers to claims management,” according to a statement.

In interviewing industry experts, Rising developed a list of areas where the industry can improve. Many of the suggestions stem from adequate training for claims handlers and supervisors on such issues as return to work, cultural awareness, empathy, active listening skills, employee engagement and communication.

The study suggested that equipping “frontline professionals with optimal interventions, while addressing the stigma of psychosocial issues and mental health conditions” can improve outcomes.

A focus on total worker health, including training on societal risk factors “that go beyond the walls of the workplace, such as housing instability or food insecurity” can also help, as can applying “community resources and social interventions for injured employees with potential health disparities,” according to the study.

Communication was also listed as a top area for improvement: “Communicate with injured workers frequently and in layperson’s terms regarding when to expect compensability decisions, indemnity benefits, medical treatments, etc.” and “(l)everage tools to engage injured workers early and frequently…  (via) text messaging, apps, and survey tools to provide immediate access to claim information.”

The study also found that communicating claim compensability and coverage issues verbally is a best practice and that if a claim is delayed, denied, or partially denied and/or medical treatment is denied or delayed pending utilization review, “communicate these decisions verbally prior to sending legalese notifications.”

Incorporating advanced analytics, including predictive and prescriptive models, “to predict and proactively identify injured worker fear or dissatisfaction with the claims process and/or medical care, as well as the potential for litigation” was also described as an area for improvement.