The Casualty Claims Environment in 2020 – Pandemic and All

With new generations entering the workforce and technology offering new data and resources, claims management has certainly evolved over the years. In contrast, antiquated administrative processes and outdated claims handling objectives remain prominent. In this session at the WSIA 2020 Annual Conference, Max Koonce, Chief Claims Officer of Casualty at Sedgwick, offered insight into the current casualty claims environment, including COVID-19’s impact.

Opioids
Interestingly, COVID-19 is dominating the media and we have not seen the same push of information about opioids that we regularly see. That being said, we are not necessarily over our opioid problems. Studies do show a decrease in use. States have put forth a great effort to decrease opioids through formularies, which has helped. We are also not seeing physicians over-prescribing like in the past. One thing to consider is – are we distinguishing accurately between the claims that may need the opioids for pain management and those that are abusing them?

Marijuana
Workers’ compensation continues to be all over the place with marijuana reimbursement. Some permit it, some do not, and some push the decision to the carrier or employer to decide. There are still a myriad of challenges with the impacts marijuana has on each individual, which is something the system will likely struggle with for quite some time.

Comorbidities
With COVID-19, we are seeing exactly how impactful pre-existing conditions can be on recovery from illness or injury. We need to flag these conditions proactively to influence how we approach the claim.

Telehealth
We are in a completely new environment. Prior to COVID-19, we were making slow strides in telehealth, but there was no big push for adoption of it. When non-COVID-19-related medical treatment stopped, it forced people to determine how we would push forward with the other medical visits that needed to occur. Telehealth was the answer. The states have been pushing telehealth as the solution for now, but where will we be post pandemic? From a medical standpoint, maybe it is time to steer certain types of visits through telehealth. Now that it is being widely used, both doctors and patients seem to love it.

Return to Work
All employees, injured or not, may be deconditioned because they are getting less activity in quarantine. It is going to have an impact when it is time to get people back to work. We need to recognize it and change the approach, whether it be a stretching routine or reminding them of the lifting process. Their safety depends on it. On the other hand, those employees out of work due to injury may not have a job to return to due to economic conditions or reduced workforce. We have to look at the law and see what we can do to get them back to light duty in some way. The longer the transition lags, the harder it is going to be to get the individual back to maximum medical improvement.

Resolution Management
There is so much negativity and debate right now. We cannot help but feel that in the environment. Prior to this, we can all agree that an injury does create an anxious moment for an injured worker. That will be accelerated now. It is our responsibility to ease the injured worker’s worry and anxiety so that they can move forward.