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

This year’s report turned to a panel of industry leaders to find out how they are tackling some of the top challenges in workers’ compensation

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

The study aims to analyze the different trends that influence claims management each year.

For the 2021 report, researchers posed discussion questions to a focus group comprised of participants from workers’ compensation insurance companies, self-insured employers, third-party administrators, and public funds to find out how successful organizations are tackling the barriers to complaints that previous reports have highlighted.

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

Rachel Fikes, Director of Experience, Director of Worker Compensation Benchmarking, Rising Medical Solutions

“The motivation 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 the interaction of group participants. “, said Rachel Fikes, director of the experiment. and Worker’s Compensation Benchmarking Study Director for Rising Medical Solutions.

“By identifying high-priority industry challenges through our quantitative survey research, and then digging deeper into both the nature of those challenges and the strategies to overcome them through our qualitative focus group research, we are able to build a more comprehensive body of research than doing just one type of survey.

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

1) How does your organization handle return to work, disputes and psychosocial issues that arise with claims?

Previous comparative studies of workers’ compensation have found that industry leaders and front-line claims professionals cite a lack of return-to-work options, litigation, and psychosocial issues such as three main barriers to strong claims outcomes.

Claims managers and front-line staff have identified these issues as the top three barriers to claims. In the 2016 survey, claims managers ranked psychosocial issues and comorbidities as the top barrier to claims; lack of return-to-work options ranks second and litigation ranks third.

When frontline claims professionals were surveyed in 2019, they named a lack of return-to-work options as their top barrier, followed by litigation, then psychosocial issues and co-morbidities.

For this year’s report, the research focus group was asked about their return-to-work goals and other claims outcomes. They also discussed barriers to achieving these goals.

Many focus group participants said their goals were for injured workers to return to work with the best possible outcomes. They want injured workers to feel that any temporary or alternate assignment is meaningful and to be actively engaged in their recovery.

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

“I think one of the ways we can do that, and which the study highlights, is to change the way we talked about returning to work. We need to start looking at a model that emphasizes capabilities, as opposed to limitations or restrictions. »

If there are biopsychosocial factors influencing a claim, focus group participants said they wanted them to be recognized by all stakeholders in the claim.

2) How are advocacy organizations advancing advocacy-based advocacy models?

After the 2019 survey identified that 72% of frontline claims professionals did not know what an advocacy-based claims model was, Rising Medical Solutions wanted to identify how organizations had advanced these models to within their businesses.

“From this research, you can see how important it is to talk to people, to be empathetic and understanding and to really actively listen to them and hear how their claim is different from someone else’s. each other,” said Melissa Burke, vice president of AmTrust Financial Services. .

Focus group members identified employee-centric models as a goal for their business, but they identified a number of barriers to realizing these models.

First, it can be difficult for claims adjusters to move on from old hostile claims practices. Some claims professionals are wary of plea-based claim models, and their first instinct may be to conduct an investigation by taking an injured worker’s recorded statements to determine which parts of the injury are compensable, the report said. But interviewing an injured worker upfront can set a contradictory tone for the rest of the claim.

“Always ask yourself, do I consider how the injured employee views this particular claim?” said Iglesias. “When possible, don’t just send a letter or email, try to talk to that person. Try explaining your decision to them.

Other claims professionals may feel they don’t have time to make material connections with injured workers due to high caseloads, creating a disconnect between company culture and day-to-day practices in terms of claims. With the industry facing a massive talent shortage that has only gotten worse due to the Great Resignation, this is a real struggle for many organizations.

But taking the extra time to make those connections can go a long way in preventing a claim from becoming contentious.

Marcos Iglesias, Chief Medical Director, Travelers and Constitution State Services

“You have to know how to escalate, how to interact, how to communicate, how to stand up for injured employees, how to make them feel safe, and know what to expect,” Burke said. “What information do they need to not be afraid, not to seek a lawyer?

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

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

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

“What is their way of life? Where does this injured employee live? Do they have access to the resources they need to help them return to work and regain their pre-injury status? Burke said.

In many cases, these factors interact with the psychosocial elements that claims professionals have been monitoring for several years now.

“Associated with these social determinants are also what we have for many years called psychosocial barriers to recovery,” Iglesias said.

This year’s panel explored these issues further by discussing how claims outcomes are improved when considering the psychological and social factors that can influence an injured worker’s recovery.

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

Leaders work actively to ensure that the social determinants of health are part of the complex lexicon of workers. They also work with their data provider partners to gather trending information 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 study results in depth this fall at National Comp 2022, Oct. 19-21 in Las Vegas.

Courtney DuChene is a freelance journalist based in Philadelphia. She can be reached at [email protected]

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