Claims management teams are constantly seeking innovative solutions to running an effective workers’ compensation program. This includes providing quality services to employees who sustain work injuries and being a zealous advocate for their clients. Part of the solution that has benefited programs in an “advocacy based” model of claims management. Studies have proven this as an opportunity to meet program objective and reduce costs in the form of quicker return to work.
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What is “Advocacy Based” Claims Management?
Under this model of claims management, the members of the claims team seek to empower employees to improve injury outcomes and get them back to work in a timely manner. This process requires interested stakeholders to be active in assisting injured workers at all steps of the claim. It also requires them to “go the extra mile” and empathize with the situations someone experiences following a work injury. Part of the process can include keeping the employee informed with details so they can in turn make decisions in their recovery.
It Starts with Words
Words mean things—especially when you are recovering from a work injury. This is a crucial step in understanding the tribulations someone suffering from a work injury is going through. It also helps with perception being reality in a positive manner.
Changing the vocabulary used during the claims management process is important. This helps refocus conversations and processes. Examples include:
- Claimant/employee: By not using these words and instead referring to someone as “a person injured at work,” it helps humanize the person and what they are going though; and
- Claims examiner: Use of these words is often outdated and reminds someone of a faceless bureaucrat sitting behind a desk. By referring to someone as a “claims representative,” it again humanizes the process.
Finding Common Ground
While members of the claims management team have a fiduciary duty to their insureds, they can also find common ground with people suffering from a work injury.
- Prescription Drug Abuse: There has been a lot said and written about prescription drug abuse in the workers’ compensation system. The common denominator among many persons who end up dying from using these medications is a personal injury. Even people with the best of intentions can become victims of abuse by not having a strong advocate. This can include members of the claims management team who help control the number of drugs consumed and by educating the people they work with about the dangers of these substances. Other activities such as monitoring a person’s intake and working with their doctors to minimize the chances of abuse are key.
- Injury response: A fast an effective injury response is another method claims management teams can employ to be an advocate on the workers’ compensation process. This starts with providing employers with the necessary tools to respond after an incident. Regular, frequent and personalized contact with a person recovering from a work injury are also key. While it might take extra time, being active in the care a person receives buys good will and breaks down barriers in an otherwise adversarial process.
- Establish expectations for all: All the main actors in a workers’ compensation claim need to take ownership over the care and recovery of an individual. For the employee, this includes concentrating on following their doctor’s instructions on rehabilitation. Employer representatives also need to be engaged and coordinate care with the claims management team.
Conclusions
Effective members of the claims management team need to be an advocate for the person involved in their claims. This starts with empathy toward the person suffering from the effects of a work injury. It also includes avoiding excessive use of prescription drugs and responding to an incident in a proactive manner. Taking these steps can reduce claims and still allow for the claims representative to look out for the best interests of a workers’ compensation program.
Author Michael Stack, CEO 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 & lead trainer of Amaxx Workers’ Comp Training Center. .
Contact: [email protected].
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