Creating an Advocacy-Based Claims Model

Advocacy is one of the most talked about concepts within the industry and holds the potential for redefining the claims process as we know it today. This session at WCI’s 2016 Annual Workers’ Compensation Educational Conference explored advocacy from a range of perspectives to show how such an approach can benefit virtually any claims program.

Speakers included:

• Tara Acton, Director Claims and Senior Corporate Counsel, CenturyLink
• Artemis Emslie, CEO, myMatrixx
• Kimberly George, Senior Vice President, Corporate Development, M&A, and Healthcare, Sedgwick
• Dr. Maja Jurisic, Vice President, Medical Director, Concentra

Advocacy puts the injured worker at the center of the claims process while stakeholders strive to provide an improved customer experience and achieve a positive outcome for that individual. While an advocacy model can take many forms, one of its core components is communicating more effectively with the injured worker from the very beginning. It also entails providing transparency throughout the overall workers’ compensation process.

Currently, there is no consistency in the system. Are we hiring empathetic people to take care of our injured workers? As an industry, we seem to be shifting far from that and placing greater concern on processes and costs. Also, there is a great need for advocacy because a litigated claim is a huge cost factor for employers. How we care for the employee through the workers’ compensation process has a huge impact on these outcomes.

An advocacy claims model can include the insertion of an objective person who is familiar with the workers’ compensation process but is not necessarily the same individual who will be deciding the claim. CenturyLink has an employee whose sole responsibility is to regularly contact injured workers every two weeks to see how they are doing, walk them through the process, customizes their return-to-work efforts and, overall, serves as an approachable resource. This process has taken often scared and confused employees and has helped gain trust from them, gets them engaged in the process and helps them return to work faster.

From a physician standpoint, advocacy means uncovering what the patient understands about the medical process to determine any misconceptions. This is not a one-size-fits-all conversation. A standard lecture will not work. If you specifically address what the patient expresses as concerns, they will listen. A respectful conversation makes a huge difference because the patient decides their own willingness to heal. There are several studies that show that patients who feel like they are heard did much better than those whose progress was tracked through numbers.

We are all better together in creating an advocacy-based approach. Your service providers can be huge allies in making the shift into how we engage and communicate to injured workers. Building trust does not happen in silos and, with a multitude of communications tools available to us through technology, we are well poised to work together on this.

Key performance indicators include measurement of experience factors. Of course reduction in litigation rates can indicate success of a program, but let’s start measuring and communicating the positive experiences. Experience really does matter and it is heavily influenced by the way we engage and communicate to our injured workers.