Insurance Business ReviewAPRIL 20248IN MY OPINIONTHE IMPORTANCE OF CLAIM ADVOCACY IN WORKERS' COMPENSATIONBy Alexandru Chirita, Workers' Compensation Manager, Americas, Volvo CarsIn 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.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 Care and compassion are at the root of claim advocacy. Always consider your employee a whole person
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