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Experts Say Advocacy-Based Claims Model Boosts Outcomes

Experts Say Advocacy-Based Claims Model Boosts Outcomes

Updated June 9, 2021 Originally published September 23, 2016
Danny Sanchez, PT, CEAS

Advocacy-Based Claims Model improves workers' comp

"Claims advocacy’ is fast getting the attention of workers’ comp claims leaders as a powerful approach to better claims outcomes. The on-demand economy has created cultural and multi-generational expectations around service, speed and simplicity, and some claims leaders have already figured out how to deliver."

That’s the word from longtime workers’ compensation veteran Peter Rousmaniere. Insurance Thought Leadership.In an article in Insurance Thought Leadership, Rousmaniere bases his conclusion on results of Rising Medical Solutions’ latest Workers’ Compensation Benchmarking Study. The advocacy-based claims model is worker-centric. It focuses on improving the injured worker’s experience. Until now, most employers have focused on corporate outcomes. Goals such as cutting costs and reducing days lost. But experts now say focusing on the worker can improve all outcomes.

In a recent blog article, Business Insurance noted, “Using an advocacy-based model for workers compensation claims can reduce attorney involvement, improve medical outcomes and speed return to work.” They explain: “At its core, an advocacy-based claims model involved designated service providers assisting and empowering injured workers at any point in the claims process.”

The Advocacy-Based Claims Model Is Gaining Traction

We live in a highly personalized world now. Consumers – especially millennials -- expect to be treated with respect. They expect to be treated as individuals. The customer is king, and employees are your consumers.

Rousmaniere notes that, “For employers, claims advocacy provides a special opportunity to directly align work injury response with their corporate brand, core values, employee communications and benefit delivery.”

So everybody benefits. The Business Insurance article notes that, “The return on investment for an advocacy-based claims model can be measured through litigation rates, claim duration, the number of medical-only claims versus lost-time claims, return-to-work rates and injured workers’ satisfaction.”

How Your Company Can Move to an Advocacy-Based Approach 

Some employers have already made the switch. They say advocacy has to be a holistic, cultural shift. Denise Algire is the primary researcher for the Workers’ Compensation Benchmarking Study. She says, “A true cultural shift will require organizations to move beyond performance metrics that are based primarily in cost containment to those based on clinical quality, functional outcomes and patient satisfaction.”

Here’s how employers are putting that into action:

  • Focus on education about the workers’ comp claims process. That sets expectations for the injured worker. And that helps reduce uncertainty and fear.
  • Quit using adversarial-sounding language such as “investigation,” “adjuster,” or “claimant.” Replace these words with “advocate,” “claims rep,” and “people.” But you cannot merely change words. They have to reflect an overall positive approach to worker’s comp claims.
  • Make it easier for employees to report an injury. Employers are using technology to help with this -- their website, call center, mobile apps. Consider allowing workers to self-report injuries instead of going through HR or their supervisor.
  • Work from the assumption that every injured worker wants to return to work. Experts note that traditional claims procedures focus on the few. That’s because employers want to catch cheaters. An advocacy-based approach focuses on the majority -- injured workers who want to recover, as fast as possible.
  • Speed things up. Yes, you may have 14 days to make a compensability determination. But a quicker decision allays fears and uncertainty. It keeps the claims process moving forward faster. The same goes for payments. Injured workers worry about paying their bills. Starbucks uses direct deposit for this, so injured employees don’t have to worry about going to the bank.
  • Communicate often and clearly. Studies show that workers who are engaged in the claims process recover sooner. And they are less likely to litigate if they feel they are being heard. Experts say sincere empathy can go a long way, too.
  • Make medical assistance the priority. Then worry about filing the claim. One insurer says immediate help may even avoid a claim. For example, your worker falls and is bruised. A triage nurse might recommend icing the area right away. That may be all the worker needs. He doesn’t need to file a claim after all. Everybody wins.

Industry experts say success depends on:

  • C-level buy-in and commitment to injured worker advocacy
  • Organizational values
  • Technology and operating systems that support and streamline claims and communications processes

But, ultimately, success depends on building trust. The Workers’ Compensation Research Institute says trust is “a key driver of claims outcomes.” An advocacy-based approach to claims fosters trust. It does that by focusing on the injured worker at every step.

On-Site Physical Therapy Supports the Advocacy Model

At the beginning of this article, we noted that today’s expectations for workers’ comp claims are:

  • Service
  • Speed
  • Simplicity

Switching to on-site physical therapy directly addresses all three goals. Modern on-site PT is a mobile, on-demand service. It requires only a small amount of space from the employer. No well-equipped clinic or gym. No investment in specialized physical therapy equipment or devices. It is patient-centric. More convenient, and less stressful.

Physical therapy sessions are strictly one-on-one, held at the injured worker’s jobsite. Each worker’s plan of care is based on their specific job tasks and working environment. They work to recover in real-world conditions. Nothing is simulated as it is in an off-site clinic. Workers remain “on the job” as they attend physical therapy treatments. That keeps them engaged with the company and co-workers. If they are off-duty, mobile PT goes to their home.

Either way, injured workers save time and hassle scheduling treatments. And traveling to and from clinic appointments. Employers can eliminate significant travel-related costs.

Outcomes also improve. Across the country, our on-site Physical Therapy clients achieve:

  • Higher return-to-work rates
  • Fewer lost days
  • Greater compliance
  • Better employee satisfaction
  • Far fewer repeat injuries
  • Cost savings

Mobile PT builds trust. It shows injured workers you care, and it keeps communication lines open. It’s simple. And fast. That’s advocacy-based service. 

We invite you to learn more about “Emerging On-Site Physical Therapy Treatment Models” at the upcoming National Workers’ Compensation & Disability Conference® & Expo, going on Nov. 30 – Dec. 2. Join us as we take an in-depth look at how Marriott International is using this model to boost workers’ comp advocacy and outcomes.

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