At the 2016 National Workers’ Compensation & Disabilty Conference, a panel discussed using an advocacy approach to workers’ compensation claims management. The panel was:
- Denise Algire – Director Managed Care & Disability Corporate Risk, Albertsons Companies
- Scott Daniels – Director of Disability, Comcast
- William Wainscott – Manager Workers’ Compensation & Occupational Health, International Paper
- Kimberly George – Senior Vice President, Senior Healthcare Advisor, Sedgwick
What is Advocacy?
Ultimately, advocacy is about taking care of people. As employers, your workforce is your most valuable asset. The advocacy approach to workers’ compensation claims handling focuses on the experience of the consumer, who in this case is the injured worker.
Building the Business Case
One of the biggest cost-drivers in claims is litigation. If you are providing a better customer experience and engaging the injured worker in their rehabilitation, you should see a significant increase in employee satisfaction. This, in turn, should decrease your litigation.
Another way to build the business case is around a culture of safety. Many employers focus on safety and loss prevention, yet when an injury occurs, they step back and let the TPA or carrier handle the claim without any employer involvement. By staying engaged with their injured workers, they show them how important they are to them and that they are concerned about their health and welfare. A voice of empathy from the employer has more impact than anything the TPA or carrier can provide.
Advocacy is multi-faceted. A big part of this is being there to educate your employees about the nuisances of workers’ compensation. They are hurt and confused. Having someone there to assist them in understanding the process can be extremely comforting.
Another reason to consider advocacy is to reduce friction in the system. There are so many different potential friction points and keeping the lines of communication open can greatly assist in resolving these issues.
Your reasoning for wanting an advocacy-based program will, in many ways, determine the structure of that program. Are you focused on reducing litigation, employee satisfaction, the interplay between different benefit programs, etc.?
It is important to align your stakeholders in your advocacy-based approach. If you have unions, they need to understand your goals with the approach so they can assist. One challenge can be changing the mindset of the unions and claims staff who are used to the conflict too often associated with workers’ compensation claims.
Workers’ compensation is just one benefit available to cover injuries and not all injuries are covered under workers’ compensation. Helping coordinate a handoff from workers’ compensation to group health or vice versa can greatly approve the employee experience. If your employer has an EAP program they can play an important role in your advocacy program.
Human Resources (HR) can play a critical role before, during and after a workplace injury. There needs to be coordination with HR on issues such as accommodating work restrictions and placement in a modified duty position. Another important aspect of this is coordination of FMLA leave with workers’ compensation so these things run concurrently. Failing to do this can cause significant confusion for both the employer and injured worker.
Another important aspect of this is changing the words we are using as they can send the wrong message. We need to review the words we are using and the communication we are sending out to injured workers to ensure the correct message is being communicated.
One of the first steps in designing an advocacy-based program is reviewing all your existing resources to see how they can assist with the program. If your company has an EAP that program, it can assist the workers with many life issues that may be unrelated to the claim, but adversely impacting outcomes.
A reduction in handoffs can significantly impact employee satisfaction. When people have to speak to one person, then another, then another, it increases frustration. Make sure your front-line contact person gathers all necessary information and shares that information with everyone in the process. It is very intimidating and frustrating for an injured worker to have to tell the same story to many different people.
You can use technology to provide resources. There are various applications and companies that can provide counseling and information to your workers to assist int he claim.
Some employers have a person dedicated to being the employee advocate and this person works with the injured worker and the claims examiner to facilitate the claim. This advocate can be the first point of contact to the injured worker, gathering informaiton and explaining the process to the worker.
Other companies use nurses as the primary point of contact with the injured workers instead of adjusters as the nurses are perceived differently by the worker than an adjuster.
All the communication you send to injured workers should be reviewed carefully as what you say really matters to injured workers. Your staff all needs to be trained and coached on using positive communication and messaging.
There needs to be transparency with your employees so they receive education explaining how workers’ compensation functions and what to expect. Misunderstanding the claims process by injured workers often leads to litigation, so anything you can do to educate the worker is very helpful.
It is important to design your program around the issues that concern your workers the most. If their biggest concern is “when do I get a check” then you need to make sure you thoroughly explain the process for getting paid, waiting periods, benefit calculations, etc.
Litigation rates are a good measure of outcome because increased employee satisfaction should result in lower litigation rates. Duration of disability can also show that you are delivering timely benefits to the injured worker. Employee surveys can also show if you are achieving what you set out to do with your advocacy-based program. The ultimate measurement of outcomes is claims costs. A program that advocates for the workers and focuses on getting them timely medical treatment with a focus on return to work should, ultimately, result in lower claims costs.