Workers' Comp

Over the last decade, the claims industry has faced a significant shift towards an advocacy-based model for injured workers. Simplifying this process has been challenging, particularly due to the negative expectations and behaviors of injured workers, identified as the top barrier to successful claims outcomes in a 2016 study. These psychosocial issues delay recovery and increase claim costs more than catastrophic injuries.

Advocacy-based models, focusing on treating the whole person, better manage these psychosocial factors. Yet, fewer than half of claims leaders report implementing such models. To become more advocacy-based, organizations can provide formal training for managers, covering cost impacts, post-injury response, roles, reporting processes, medical management, and return-to-work programs, with regular updates.

Adopting a 24/7 physician triage model also shows promise. Here, physicians assess injuries via video or phone, establishing care plans and return-to-work programs. This approach handles 76% of workplace injuries virtually, recommending in-person care when necessary and setting transparent expectations for workers.

Effective advocacy programs focus on four key areas:

  1. Communication: Establish trust and reduce stress by maintaining contact from the moment of injury until the claim is closed. Use phone calls, emails, get-well cards, and web portals to communicate empathetically.
  2. Education: Train frontline supervisors on injury response and communication. Ensure medical providers understand return-to-work programs and job descriptions. Explain the workers’ compensation system to injured workers.
  3. Transparency: Keep workers updated on claim progress to build trust and reduce litigation risk.
  4. Measurement: Develop KPIs to track injuries, claims processes, and organizational responsiveness. Measure return-to-work rates and employee satisfaction to foster an advocacy culture.

A worker-centric claims process benefits both employers and employees, leading to faster recoveries, lower costs, reduced litigation, and increased workforce health and productivity.