Thought Leader: Expanded Approach to Claims Management Leads to Better Outcomes for All

01 May, 2019 Nancy Grover

                               

Boston, MA (WorkersCompensation.com) – The standard claims management efforts just won’t cut it anymore. At least, not for companies looking to decrease their litigation rates by 20 percent or more.

That’s the message from Kathy Tazic, managing director of Client Services at Sedgwick. Speaking during a RIMS session, Tazic outlined specific steps stakeholders can take to better engage injured workers, improve their outcomes, and reduce costs for payers.

Claims management must evolve into a “helping process,” she explained. It’s an “industry transformation” that Sedgwick embarked on five years ago.

The strategies include: 

  • Changing the language. “There’s a lot of technical jargon we use,” she said of the industry. “We need to let injured workers know it’s about helping them, we’re not trying to ‘catch’ them.”  The language needs to be simplified where possible and/or explained to injured workers. 
  • Denial process. Changing the language surrounding denied claims makes a difference. “Instead of saying, you’re claim is denied,’ change it to say, ‘you’re not eligible for workers’ compensation, but here are some other avenues.’” Providing other resources has a direct impact on whether an injured worker seeks out an attorney. “It lowers the litigation rate.” 
  • Create a journey map. “What’s the journey for the injured worker,” Tazic said. Creating a map of the anticipated experience for the injured worker shows the employer where it can interact with the injured worker, “to make it easier for the person to return to work,” she explained, “and it lets the employer know they must be part of the process.”
  • Evolution of volunteer RTW. Placing the injured worker with a charity that’s meaningful to the employer gets the worker back to function. While some enjoy the work, many don’t, leading them to return to their regular jobs sooner. For organizations where the concept might be a hard sell, such as those with unions involved, Tazic suggests trying it as a pilot program in one state or one area and tying it to the dollars once it’s established.
Measuring Success

Employers who have implemented the four strategies have seen their litigation rates decrease by up to 20 percent, Tazic said. “We think it can be even higher than that.”

Additionally, the companies have seen a reduction in lost work days; specifically, the claims closure rate within the same year of the injury. “It’s about 75 percent,” Tazic said. “We want it closer to 80 percent. It leads to specific savings.”

Advocating for the injured worker leads to better engagement, which results in better outcomes and lower costs, she explained. One key is educating and informing the worker.

“If he’s having surgery, let him know what to expect,” she said. Also explain “where their doctor is, and how often we need them to check in with us.”

Some employers also stress referrals to wellness activities such as smoking cessation programs and EAPs. Adjusters these days “need to be aware of these things,” she said.  “It’s a change in how adjusters look at their jobs.”

Getting adjusters on board with the changes is not always “an easy flip,” Tazic said. “It takes education and using examples, and the employer has to commit” to the idea.

 


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    About The Author

    • Nancy Grover

      Nancy Grover is a freelance writer having recently retired as the Director, Media Services for WorkersCompensation.com. She comes to our company with more than 35 years as a broadcast journalist and communications consultant. Grover’s specialties include insurance, workers’ compensation, financial services, substance abuse, healthcare and disability. For 12 years she served as the Program Chair of the National Workers’ Compensation and Disability Conference® & Expo. A journalism/speech graduate of Ohio Wesleyan University, Grover also holds an MBA from Palm Beach Atlantic University.

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