Carrier Roundtable
At the 2023 SAWCA Annual Convention, a panel addressed issues specific to the workers’ compensation carriers who provide coverage for many employers across the nation. This panel included:
- Carey Armistead – Sompo International
- Patrick Hiles – Safety National
- Max Koonce – Sedgwick
- Moderator: Tom Glasson – AIG
Impeding Processes and Procedures
Regulators need to ensure their requests facilitate the process of handling claims, taking into account the vast differences in required paperwork per state, ranging from 15 to 192 workers’ compensation claims forms. With so much focus on the process, this distracts from the real priority, the injured worker themselves. Given the amount of data that can be provided electronically from payers to the states, why are all these forms still necessary?
With such a strong focus on adhering to technical compliance, the bigger picture can be ignored. A company with a small presence in a state can fail to meet audit thresholds with only a couple errors. Penalties will be enforced for every compliance violation found, even though overall compliance may be well over 90%.
Technology advances can assist in overcoming challenges including staffing shortages and mailing delays. A transition to electronic mailing could eliminate many of these issues.
Indemnity Benefits Payments
A few states still mandate paper checks for indemnity benefits. Other states allow TPAs or carriers to use debit cards or direct deposit for payments to injured workers. Many workers are already accustomed to receiving direct deposit for their payroll, so paper checks can disrupt their routine. The goal should be to make the employee experience in workers’ compensation payments as close to what they are used.
Direct deposit eliminates a lot of system conflict and angst from the injured worker who relies on these payments. Delays in the mail system happen frequently, and can further disrupt their routine. Younger injured workers want to be able to use Zelle, Venmo, or other electronic fund transfer apps for payments, as that is what they are used to.
Serving the Injured Worker’s Needs
The system is getting much more complex and the complexity creates poor experiences for workers. For example, a worker goes to a doctor who requires a claim number to see them. However, the claim has not been reported yet to the carrier so the injured worker does not have the information required to begin care.
The system works well for minor claims and seriously injured workers, but the middle-ground claims tend to get convoluted and can end up in litigation.
Worker expectations are evolving in terms of what they desire from a customer service standpoint. Younger injured workers want communications through texting, not emails or phone calls. They are used to mobile apps, and deem platforms like online portals as antiquated systems.
Over 90% of claims move through the system with few challenges, and this success rate can be lost in critiques of the system. Overall, only a very small percentage of claims end up in litigation.
Access to Care Challenges
An increasing number of medical providers do not want to deal with the workers’ compensation system, and if they do, they are unwilling to accept the fee schedule. Some do not want to handle the intense paperwork involved. However, the amount of paperwork can vary greatly by state.
In rural areas, there can be significant challenges with access to specialized care, transportation, and home health providers.
Carriers and TPAs need to consider their efforts in encouraging medical providers to participate in the workers’ compensation system. When possible, motivating providers to use telehealth can also help expedite care. However, state limitations requiring the use of in-state medical providers can hinder this process.
Regulators need to adapt adjuster residency requirements to align with the realities of how claims are administered. Most claims adjusters are now fully remote, and systems are completely electronic. They can handle claims from any jurisdiction anywhere in the country. However, some jurisdictions still require the adjusters to be physically in the state.