Health

3 Takeaways from Rising Medical’s 2021 Workers Compensation Benchmarking Study: Risk and Insurance

3 Takeaways from Rising Medical's 2021 Workers Compensation Benchmarking Study: Risk and Insurance

This year’s report turned to a focused group of industry leaders to find out how they tackled some of the biggest challenges for workers firms

Last month, Rising Medical Solutions released its ninth annual workers compensation calibration study.

The study seeks to analyze the different trends that affect claims management each year.

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For the 2021 report, the researchers asked discussion questions to a focus group of participants from workers’ comp insurers, self-insured employers, third-party managers and state funds to see how high-performing organizations are addressing claims hurdles that previous reports have. highlighted.

This is the third time the study has taken a focus group approach to their research. The first time was in 2015 and then again in 2018.

Rachel Fix, Chief Experience Officer, Director of Workers Compensation Measurement Study, Escalating Medical Solutions

“The impetus for using focus group research is to increase the level of detail, candor, and insight behind participants’ recommendations and experiences in order to generate data that would otherwise be inaccessible without group participant interaction,” said Rachel Fix, Senior Experience Officer. and Director of the Benchmarking Study of Workers’ Compensation for Development of Medical Solutions.

“By identifying high-priority industry challenges through quantitative survey research, and then delving into the nature of those challenges and strategies to overcome them through our focused, qualitative group research, we are able to build a body of research that is more comprehensive than doing one type of investigation alone.”

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This year’s focus group focused on three main questions:

1) How does your organization manage the return to work, litigation, and psychosocial issues that arise in litigation?

Previous workers’ compensation benchmarking studies have found that industry leaders and frontline claims professionals name a lack of options to return to work, litigation, and psychosocial issues as the top three obstacles to strong claims outcomes.

Claims leaders and frontline staff both described these issues as the top three impediments to the claims. In a 2016 survey, claim leaders rated psychosocial problems and comorbidities as the number one obstacle to claims; The lack of options to return to work came second and litigation ranked third.

When frontline claims professionals were surveyed in 2019, they said the lack of options to return to work was their biggest obstacle, followed by litigation and then psychological issues and comorbidities.

For this year’s report, the research focus group was asked about their goals for returning to work and the results of other claims. They also discussed any obstacles to achieving these goals.

Several focus group participants said their goals were to get infected workers back to work with the best possible results. They want injured workers to feel that any temporary or alternative assignments are meaningful and to be actively involved in their recovery.

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“We are doing everything we can to maintain business at the center of an individual’s recovery,” said Dr. Marcos Iglesias, vice president and chief medical officer, Travelers.

“One way I think we can do that, which the study points out, is to change the way we talked about going back to work. We need to start looking at a model that focuses on capabilities, rather than constraints or constraints.”

If there are bio-psychological factors influencing the claim, focus group participants said they wanted it to be recognized by all stakeholders in the claim.

2) How do claims organizations develop advocacy-based claims models?

After a 2019 survey determined that 72% of frontline claims professionals do not know what an advocacy-based claims model is, Rising Medical Solutions wanted to determine how organizations are developing these models within their companies.

“With this research, you can see how important it is to talk to people, provide empathy and understanding, listen effectively, and hear how their claims differ from those of others,” said Melissa Burke, Vice President, AmTrust Financial Services. .

Focus group members identified employee-centered models as a goal for their companies, but they identified a number of barriers to achieving these models.

First, it can be difficult for claims organizations to move on from past adversarial claims practices. The report said that some claims specialists do not trust advocacy-based claim forms and their initial instinct may be to conduct an investigation by taking recorded data from an injured worker to determine the compensable parts of the injury. But questioning the injured worker immediately could set a hostile tone for the rest of the claim.

“Always ask yourself, Am I thinking about how the injured employee views this particular claim?” Iglesias said. “When possible, don’t just send a letter or email, try to talk to that person. Try to explain to them how you made the decision.”

Other claims professionals may feel that they do not have time to make physical contact with injured workers due to the high number of cases, resulting in a disconnect between company culture and daily claims practices. With the industry facing a massive talent shortage which has been exacerbated by major resignations, this is a real struggle for many organizations.

But taking the extra time to make these connections can go a long way toward preventing a claim from becoming disputed.

Marcos Iglesias, chief medical officer, Travelers and Constitution State Services

“You need to know how to take it to the next level, how to interact, communicate, advocate for injured employees, how to make them feel safe and know what to expect,” Burke said. “What information do they need to know so that they are not afraid, not to contact a lawyer?”

Some of the strategies highlighted in the report to ensure that injured worker advocacy is used during the claims process include adopting new practices designed to focus the employee experience. Including frontline claims professionals in the design process of these new practices can help ensure that they are practical and easy to implement.

3) How are social determinants of health taken into account in workers’ firms?

Last year’s survey assessed the social determinants of health and whether claims professionals were able to identify them in the context of a claim. Social determinants of health are the economic and social elements – such as access to transportation and safe housing – that can affect the recovery of an infected worker.

“What is their lifestyle? Where does this injured employee live? Do they have access to the resources they need to support them in returning to work and returning to their pre-injury condition?” Burke said.

In many cases, these factors interact with the psychosocial elements that specialists have been pursuing for several years now.

“The association of these social determinants is also what we have been calling for many years now with psychosocial barriers to recovery,” Iglesias said.

This year’s focus group examined these issues further by discussing how to improve claims outcomes when considering psychological and social factors that may influence the recovery of injured workers.

Although focus group participants expressed a desire to have their organizations understand and deal with the social determinants of health during the recovery process, a lack of awareness of these issues often prevents claims professionals from directly addressing these factors.

Leaders are actively working to ensure that the social determinants of health are part of the workers’ corporate lexicon. They also work with their data supplier partners to gain insights to chart trends that will help claims professionals identify these factors early in the recovery process and intervene if necessary. &

Fikes, Iglesias, and other industry leaders will discuss the results of the study in depth this fall at the National Comp 2022, October 19-21 in Las Vegas.

Courtney Duchene is a freelance journalist based in Philadelphia. It can be accessed at [email protected]

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