Establishing Client Service Instructions (CSI), written in cooperation with your workers’ compensation claim partners, that reflect the core values of your organization provide a formal communication tool that sets expectations to all invested parties. This 2017 National Workers’ Compensation and Disability Conference session, presented by Ronda Ostrander – Director, Associate, and Occupational Health and Wellness Manager at Ascension Health and Sam McMurry – Executive Director of Texas Self Insurance Association, walked through how to create, manage, and measure CSIs.
The purpose of the CSI is to establish expectations and commitments of the employer, adjuster, carrier, and any other involved party when engaged in the claims process. The CSI provides clear criteria for measuring results and establishes the framework of how goals will be achieved. The tone should be be in harmony with the philosophy of the employer and, though it is a formal and contractual document, it should be able to be clearly understood by all who are part of the process.
The primary consideration of an employer when constructing a meaningful CSI should be: What constitutes a successful post-injury management program? While there are guidelines of what should be included, the goals and outcome will be specific to each employer. They should define the associate’s experience through the program, itemize the claims cost, and provide the ability to trend data and measurable results. An employer should be mindful to consider what is critical to fit into the organization’s culture, what will be non-negotiable, and what they are willing to pay for to provide a successful outcome.
The presenters and session attendees came up with a brief list of potential items to consider in CSIs:
• Examiner Case Loads/Staffing
• File Reviews
• Compliance with Jurisdictional Requirements
• Settlement Authority
• Approved Vendors
• Escalated Claims
Measurable performance criteria should be defined to determine not only the success of the experience, but allow the CSI to be a living document that can be improved. Instructions must be specific and goals objective. Key measurement areas include associate experience, claims cost, and data/measurable results. Early intervention is key to supporting the associate, helping navigate next steps, who to contact, and what they are and are not entitled to. To ensure positive morale, set mileposts of transitional duties and return-to-work benchmarks and dates. Claims cost criteria can consider carrier/TPA penalties versus employer penalties, medical management (ODG guidelines), reserve changes, and litigation. Data/measurable results can be considered by RTW/transitional duty dates (when scheduled, when actually accomplished), medical only versus indemnity, and closing ratios.
CSI’s should establish skin in the game. Consider financial incentives to examiners for meeting performance expectations, money at risk from TPA/carrier to employer, or a combined approach. Self-insured employers commonly have risk sharing agreements in place and part of payment is withheld from the TPA if criteria goals are not met.
Dedicate resources to assessing CSI results. Did performance meet the promise? Establish the frequency of assessing results, who conducts the formal assessment, and who receives the assessment and is responsible for taking action. Remember that the CSI is a living document. As program performance changes, program needs change, or program failures are identified, CSIs should be re-evaluated and everyone should be prepared to take action.