In today's world, it is not uncommon for people to distrust the insurance claim process. Frankly speaking, most injured workers do not trust workers' compensation insurance adjusters or someone else's decision-making in a situation that dictates their medical care. It is a common misconception, as analyzed during several prior interactions with injured workers that the goal of insurance companies is to close claims and move them along quickly at the expense of their health or wellbeing. If you couple that thought process with today’s non-verbal technological landscape, employers are already behind the eight ball with expensive lawsuits and upset employees.
This is where claim advocacy is brought in. Claim advocacy is an evolving concept in workers' compensation, emphasizing employee-centric customer service during the recovery process. This approach aims to eliminate adversarial challenges, streamline benefit access, foster trust, and hold organizations accountable for metrics beyond cost reduction. High-performing organizations often adopt these strategies as part of their talent management and to enhance claim outcomes. This trust will translate to reduced unnecessary litigation on claims because employees won’t feel they need an attorney to advocate for them. It will also create a happier workforce where employees feel valued. Remember, they will generally continue to work for you at the conclusion of their claim.
Care and compassion are at the root of claim advocacy. Always consider your employee a whole person
Injured workers are already dealing with the negative initial thoughts following injury: How am I going to get paid and take care of my family? How am I going to be able to work for 20 more years with this injury? How are medical bills going to be paid for all these visits? All these questions are simply answered by competent HR professionals, caring supervisors, and a TPA who is aligned with your goals of getting questions answered in a timely manner. Competency can come from adequate training, perhaps from your defense attorney or workers’ compensation manager in the applicable state’s workers’ compensation laws and regulations. Empathy, on the other hand, is built in all of us; we just need to tap into it.
Some elements of claim advocacy include but are not limited to:
Immediately Addressing Medical Needs: By doing this, you always show positive intent to employees. The allowance for medical treatment will always come first. Studies show that early treatment intervention leads to faster recoveries. It is also one of the first times employees will feel cared for. Refusal to provide medical treatment is a common reason for attorney representation.
Communicating Precisely and Concisely: Once initial medical treatment has been sought, personally call and email the injured worker to explain your role. Keep confusing 'WC lingo' such as compensability, NCM, medical terminology, etc., at a minimum. By doing so, you give the clearest possible explanation of the beginning of the WC process. Consider an intro letter that explains what will happen once a claim is submitted and provides notification regarding additional expected phone calls from your partners. Early on, perhaps in the first 1-2 months following injury, check back with the injured worker every week to reiterate your role and help answer questions, even if there are no relevant changes in their claim.
Being Transparent: Like the step above, educating injured workers on the roles and names of parties assigned to the claim file is important. Explain why they will be assigned and how they will benefit the injured worker. Keep the injured worker abreast of relevant changes to their claim, both good and bad.
Showing Care and Compassion: Care and compassion are at the root of claim advocacy. Always consider your employee a ‘whole person.’ Putting yourself in the shoes of the injured is important. Understand that this is most likely the first time a team member is going through something like this, so alleviate any worries from the start. From frontline supervisors to safety and HR, all parties in your organization are encouraged to speak with care and compassion. The same mindset should be instilled in your external partners— basically anyone and everyone who will be in direct contact with the injured worker.
Having Empathetic Patient Engagement: This is important to push to your medical partners. Having a strong medical partner who is willing to understand the root cause of the injury and willing to listen is important in providing the best patient care. A strong medical partner understands the incident details that come from you as the employer, and the mechanism of injury reads incident statements and appropriately assesses causation.
Simplifying as Much as Possible: Creating seamless processes from the start, such as having the team member complete all necessary workers’ compensation documents in one sweep, will alleviate the ‘formalities.’ Going back to communication, it is important to speak clearly and take the time to explain things. Always being there as the contact for the team members and the central knowledge base will keep things simple. Explain the different people assigned to their claim and how these parties will benefit the team members and engage them to provide the best outcome.
