7 Steps To Implement Advocacy Based Claims Model

The ‘advocacy-based claims model’ is the new buzz term in the workers’ compensation system. It relies on the old adage that you can catch more flies with honey than with vinegar. We’re increasingly seeing it in the movement to focus attention more on the injured worker than on the complicated processes that typically encompass workers’ compensation claims handling.

Proactively communicating and focusing attention on the injured worker is a best practice that has worked extremely well for the past 30 years (read one of this blog’s earliest posts here), and it will continue to work well for the next 30 years. What is encouraging is the growing adoption that improving outcomes for the injured worker leads to lower costs for the payer.

Benefits of Advocacy Based Claims Model

Companies that have adopted an ‘advocacy-based claims model’ are finding a multitude of wins:

lower litigation rates
expedited return-to-work
and happier, more productive workers

…all of which can translate to major cost savings. Simply put, it’s the idea that by making the injured worker part of the claims equation rather than an outside observer, he will have more buy-in for his own recovery and work with, rather than against those involved in the claim.

Injured workers who feel their employers actually care about them and are willing to work with them are more likely to feel empowered and valued and, thus, less likely to thwart return-to-work efforts. They have a better understanding and appreciation of the process, which can eliminate much of the confusion and frustration injured workers often experience.

Implementing changes doesn’t need to be formal, complicated — or expensive. Much of it involves treating the injured worker with respect and as an integral part of the workforce.

Steps To Implement Advocacy Based Claims Model

There are several steps that any organization — regardless of size or type — can take to reduce the adversarial nature of the claims process and avoid letting injured workers with seemingly minor challenges slip through the cracks and into the 5 percent of claims that drive the majority of workers’ compensation costs.

Steps to implementation include:

Immediately address medical needs. When a worker is injured, the first order of business should be to address his medical needs — not filing a claim. This can be easily accomplished by leveraging a best-in-class injury triage provider. In fact, by getting treatment immediately, a claim can often be avoided.

Communicate early, often and clearly — and maintain the dialogue throughout the claims process. Designate someone – in Human Resources, Risk Management or a supervisor to contact the worker on a regular basis to see how he is doing and how the process is going.

Educate and inform. If possible, have a medical person, such as a triage nurse explain the medical processes involved. The workers’ compensation system is fraught with complexities. Let him know how the process works, what to expect, and how he can help the process along. Also, let him know who will be involved along the way and whom to contact with questions

Show compassion. Sending a get well cards for example, is easy, inexpensive and effective and lets the workers know he is a valued member of the team.

Watch your language. The word “claimant” should be replaced by “injured worker.” Instead of “investigator” or “adjuster,” use the term “advocate,” as it implies the person is working with, rather than against the employee.

Consider the worker a whole person — with personal issues outside of work that may affect his recovery, rather than just a body with an injury.

Simplify the process wherever and whenever possible. For example, a company’s website or mobile app can be used for employees to report an injury immediately and easily, rather than having to figure out whom to approach and what information is needed.

Taking simple steps toward an advocacy based claims model focused on can lower your litigation rates, reduce claim durations, cut down on the number of lost time claims vs. medical only claims, improve RTW rates and improve workers’ satisfaction.

Trust Biggest Factor in Claim Outcomes

The amount of trust between the injured worker and the company is the biggest factor in the claim outcome. When injured workers trust that you care about them and are doing all you can to facilitate their recoveries, they are more likely engage in the process and do whatever is necessary to return to work.

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%. He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: https://blog.reduceyourworkerscomp.com/

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.