Last month we started a series of newsletters (February) to introduce the concept of data enrichment of claims information and we discussed how this will help us to understand what’s really preventing return to work for complex claims.
Maybe for those short term disability plans of 3 to 6 months, the duration is driven by diagnosis. In the healthcare industry, recovery is measured over a 6 month period. So by its very nature a claim that has gone on longer than 6 months has complications…
We have been told for many years in the claims world that we should not over medicalize claims, yet when claim managers get stuck, they order an IME!
We know that the likelihood is that there is something else going on: work issues, poor motivation, anxiety, depression, domestic issues, medication dependence, etc. on top of the primary diagnosis.
These are the psychosocial factors, that after the first few months of a claim, should really be driving our claim management process.
An experienced claim manager could, probably after 7 mins on the phone, start to dig into some of these issues, BUT we don’t have many experienced claim managers any more, and if we do, their case loads are too high, and new claim managers are lacking the required skills.
Just imagine for a moment, that we had developed a way of understanding these psychosocial influencers without the need for an experienced claim manager!
The Claim Lab is an organization that has been conceived to help Disability and Worker’s Compensation Insurance companies improve claims outcomes using innovative techniques. Learn more at www.claimlab.org.