About the Study Program:

The Workers’ Compensation Benchmarking Study is a national research program examining the complex forces impacting claims management in workers’ compensation today. The study’s mission is to advocate for the advancement of claims management by providing both quantitative and qualitative research that allows organizations to evaluate priorities, hurdles, and strategies amongst their peers. Conceived and directed by Rising Medical Solutions, the Study addresses the gap in available research focusing on how claims organizations deal with industry-wide operational challenges.

Today, the ongoing study program is a collaboration of workers’ compensation leaders who represent diverse perspectives and share a commitment to providing meaningful information about claims management trends and best opportunities for advancement. Recognizing the need for an unbiased approach, the study is guided by an independent Principal Researcher and an Advisory Council of industry experts whose involvement is critical to maintaining a framework that produces impartial and compelling research.

About the 2013 – 2018 Studies:

2013: The first annual Workers’ Compensation Benchmarking Study addressed widespread claims management challenges in these key areas: prioritizing core competencies, measuring best practices, incentivizing operational excellence, training and retaining staff, managing technology and data, and evaluating medical performance management. Results quantified and illuminated several critical issues limiting claims organizations’ talent pool, technology potential, and performance abilities. Summary of Results | Request Report

2014: Building upon the robust 2013 Study, 2014 efforts concentrated on developing multi-year trend data, delivering further insights around the challenges revealed in 2013, identifying any potential shifts in operational focus, and assessing the impact of the Affordable Care Act. Request Report

2015: To answer the fundamental question of how organizations turn the challenges identified in the 2013/14 studies into opportunities and action, qualitative focus group research with industry executives replaced the quantitative survey approach. The ensuing Insights Report synthesized three years of research into an incisive, “solutions roadmap” for claims leadership going forward. Summary of Results via CLM WC article | Request Report

2016: This study broke new ground by substantiating which claims best practices generate better outcomes. Nationwide survey results coupled with the cumulative intelligence of nearly 1,200 claims leaders provides a convincing, data-backed profile of the higher performing claims organization. Success differentiators include linking key performance indicators to desired claim outcomes, leveraging numerous data sources to develop analytics, and engaging sooner in emerging and/or particularly challenging industry areas. Request Report

2017: Reprising its 2014 survey questions, the 5th Annual Workers’ Compensation Benchmarking Study provides an industry report card by measuring advancement in claims management over the past three years. Additionally, it reveals a more robust profile of the successful claims organization with an expanded set of practices differentiating them from lower performers. Lastly, the study continues its exploration of the emerging “claims advocacy” approach to engaging injured workers. Request Report

2018: Since the study launched in 2013, claims leaders have consistently ranked medical management as the core competency most critical to claim outcomes. With medical costs representing over 60 percent of claims costs in many jurisdictions, the study’s Advisory Council recommended the 2018 study further investigate what high performing claims payers are doing to surmount this top industry challenge. Request Report

About the Principal Researcher & Study Report Author:

Denise Zoe Algire, MBA, RN, COHN-S/CM, FAAOHN,
Director of Risk Initiatives & National Medical Director |
Albertsons Companies

Denise Zoe Algire serves as the principal researcher and report author for the studies. She is a nationally recognized expert in enterprise risk management, managed care, and integrated disability management. She is board certified in occupational and environmental health and is a fellow of the American Association of Occupational & Environmental Health Nurses. Bringing more than 20 years of industry experience, her expertise includes claim operations, medical management, risk management, and healthcare practice management.

About the Study Director & Publisher,
Rising Medical Solutions:

Rising Medical Solutions (Rising) is a national medical care and cost optimization company that serves payers of medical claims in the workers’ compensation, auto, liability, and group health markets. Rising conceived the study idea and leads the logistical, project management, industry outreach, and publication aspects of the effort. For study inquiries, please contact Vice President and Study Program Director, Rachel Fikes.