Mutual Trust Key to Claims Advocacy Success

Psychosocial issues pose the biggest barrier to successful claim outcomes, according to Rising’s 2016 Workers’ Compensation Benchmarking Study. Citing best practices from The Hartford, CNA, Nationwide, and Albertsons, Rising recently released a white paper examining how claims advocacy principles are better suited to overcome psychosocial factors than adversarial, compliance-driven, and task-based claims styles.

I have always been a proponent of advocacy-based claims management. Treating the injured worker as a whole person rather than an isolated injury is a better recipe for timely recovery, particularly given that the nature of injury cannot predict how an individual will react to their specific situation.

This is why we hear inspirational stories of individuals who lose a limb, for instance, and still run marathons, climb mountains, and exceed all recovery expectations due to good coping skills; while others with less catastrophic injuries will grapple with non-medical impediments that delay their recovery. A claims program rooted in advocacy identifies workers facing psychosocial obstacles early in the claim and helps them address behaviors and predicaments that can derail return to work.

What resonates with me most from the white paper is the consensus among claims leaders that mutual trust is a linchpin of claims advocacy. Adjusters must trust that the individual’s injury is legitimate and their psychosocial issues are genuine, and injured workers must trust that the adjuster’s empathy is sincere and their guidance is in the individual’s best interest. Claims advocacy models only work if both parties trust they share the same objective: the employee’s timely return to work at equal or better health than before the injury.

At Rising, one way we establish trust with injured workers and aid our clients’ claims advocacy efforts is to have Rising nurses conduct screenings for high-risk cases, including those where psychosocial comorbidities may be present. Injured employees are oftentimes more comfortable confiding emotional distress or hardships to a medical professional than to a non-medical professional. Understanding an employee’s state of mind and behavioral dynamics, in addition to their injury details, enables our nurses to recommend the right intervention protocols to address psychosocial impediments during the course of recovery.

While employee coaching and cognitive behavioral therapy (CBT) are interventions often used to curb psychosocial issues themselves, we’ve found that even the simplest forms of assistance can generate continued trust and confidence in the recovery process. For example, arranging transportation to a doctor’s appointment or scheduling a consultation with a specialist is straightforward care coordination that can have tremendous impact on the status of a claim depending on the injured employee’s perceptions, morale, and/or personal circumstances.

Ultimately, treating injured workers as the valued customer at the center of a claim perpetuates trust, is the right step forward for our industry’s service model, and helps remove barriers to positive claim outcomes.