Who Will Establish "Excellence in Recovery" Best Practices for Workers' Compensation Claims Handling?

25 Jul, 2019 Bob Wilson


Earlier this week we discussed the concept of “caseload caps” for adjusters and claims handlers who manage workers’ compensation injury cases. It was a topic that produced a decent amount of comment activity, both within this blog, on LinkedIn and elsewhere. Many people appeared more prepared to endorse the idea than originally anticipated. Some added that the idea has merit but does not standalone as a panacea for the problem. One commenter rightly pointed out that without informed and properly trained employers, adjuster caseload is virtually irrelevant. 

We’ve had numerous discussions over the years about how employers can be their own worst enemy and can easily torpedo the outcome of a claim before the insurance company even knows it exists. Clearly there are other issues to address. 

Most commenters seemed to feel that caseload caps are a good idea, but the consensus seemed to be that government driven standards would not be the ideal solution. This leads us to look into a second concept that was broached during our recent Hot Seat Webinar, where this entire conversation began. It was Judge David Langham who suggested that as an alternative to regulatory caseload restrictions, the industry could somehow establish standards that could be voluntarily adopted. These claims handling “best practices” could support many of the recovery-centric and advocacy-based ideas that are making inroads within the comp arena and would be something claims managers could leverage in the marketing of their services.

The best practices concept would be a complex project, as it would need to consider and accommodate the various types of injury claims we see. Not all situations are the same, and one solution here clearly would not fit all. The ideas would need to be broad enough to cover, in addition to voluntary caseload guidance, training, communication and performance accountability. There should even be an element that incorporates “employer development,” helping to develop knowledge and skillsets where they can be most critical; at the point and time of the injury itself.

But again, we ask the question, “Who will lead the discussion to develop what I am calling ‘Excellence in Recovery’ best practices?”

The adversarial nature of workers’ compensation means that different people and groups see and experience things differently. This continually challenges the industry, as consensus on even single issues is difficult to reach. Years ago, I moderated a panel at an American Bar Association conference, where an attorney on the panel lambasted health care within workers’ comp. He pointed out the well-known fact that patients in the workers’ comp system take longer to heal than those with similar issues who are being treated under general health programs. His point was that medical care in comp is substandard. I later pointed out that I have cited the same anecdotal observation, except in my example it is to demonstrate that people take longer to heal when they are being paid to stay home. 

The same generally accepted fact, yet two completely different viewpoints. Which one of us was right? Or are we both partially correct, with the kernel of truth lying somewhere between our two opinions? 

Finding that kernel and providing needed balance will be the secret to developing effective best practices for workers’ compensation claims handlers. Finding the voices that can establish that balance will be tricky, but not impossible. In 2016, Judge Langham and I were involved in a series of meetings called the Workers’ Comp Summit, or the “National Conversation on Workers’ Comp.” They consisted of several days of meetings in 3 cities across the country, and included representatives of most sectors that deal in workers’ comp. They were exhausting, yet enlightening. The focus of that effort was to define areas of needed improvement for the workers’ comp system, and largely we were able to reach a consensus on 29 “Imperative Issues” within the industry. The same type of debate and consensus focused on claims handling issues could produce a workable set of standards that could be utilized.

The question, again, is, “who?” What groups will lead the effort to organize and establish these “Excellence in Recovery” standards? Can we as an industry agree to come together and define the best way to manage the injuries of people in our care? 

This post is not designed to provide that answer, but rather intended to spark the discussion. An Excellence in Recovery plan could produce even better results than a regulatory cap on caseloads. And it could provide excellent marketing possibilities to TPA’s and claims managers who could promote themselves as EIR compliant. 

Excellence in Recovery Best Practices. Better outcomes, lower costs, healthier workers and happier adjusters. Everybody wins; dependent, of course, on our ability to lead ourselves to that outcome ourselves.

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