2021 Report Summary
The ninth annual study draws upon first-person, focus group research and reveals real-world strategies industry executive participants are using to overcome deeply entrenched challenges. Eight years of prior study data shows—to succeed in the face of core claims challenges—organizations must undergo operational transformation to improve outcomes.
With claims, clinical, and medical management perspectives, the research exercise generated expert guidance payers can use to drive success by: (1) surmounting the repeatedly ranked top obstacles to achieving desired claims outcomes, (2) moving from tactical to strategic, cultural change in the execution of employee-centric claims models, and (3) operationalizing social determinants of health (SDOH) best practices.
The resulting 2021 Report details specifically how high-performing claims organizations are transforming legacy processes, mindsets, semantics, and ingrained cultural practices to outpace their peers and propel new levels of claims management mastery.
2020 Report Summary
The 2020 study marks the first time claims leaders had the opportunity to respond directly to the perspectives of more than 1,200 frontline claims professionals who participated in the 2019 survey. Additionally, the 2020 study examines organizational resiliency in our industry – including COVID-19’s impact on claims operations and what high performing claims organizations are doing to future-proof their organizations that lower performers are not.
2019 Report Summary
For the first time ever, the study surveyed frontline claims professionals (instead of claims executives) to ascertain alignment between industry leadership and staff who directly handle workers’ compensation claims. As the industry’s largest talent constituency, with the greatest influence on financial and injured worker outcomes, the 2019 Report provides visibility into how the views of frontline staff mirror or differ from claims executives and highlights opportunities to advance the entire industry.
2018 Report Summary
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.
2017 Report Summary
Reprising its 2014 survey questions, the fifth 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.
2016 Report Summary
For the first time in its four year history, the 2016 study identifies which claims best practices are generating better outcomes and clearly differentiating high performing claims organizations from industry peers. Results from this nationwide survey of 492 claims leaders substantiate various methods that drive claims success. Building on the cumulative intelligence and research with nearly 1,200 claims leaders, the 2016 study provides a convincing, data-backed profile of the higher performing claims organization.
2015 Report Summary
Based on resounding feedback from claims professionals who have asked exactly how to overcome the widely-faced operational challenges identified in the 2013/14 studies, the 2015 study brought a new approach to the program – qualitative, focus group research. Drawing upon collaborations and interviews conducted throughout the year, Industry Executive participants related the prior years’ survey results to their strategic visions for future advancement. The ensuing 2015 Insights Report synthesized the past three years’ research into an incisive, “solutions roadmap” for claims leadership going forward. In addition to the full report, we’ve provided a study summary via this CLM WC article.
2014 Report Summary
Building upon the robust 2013 study, efforts in 2014 focused 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.
Top issues confronting claims organizations involve addressing the rapidly shrinking talent pool, grappling with emerging technology trends, and operationalizing performance measures…all while improving productivity and reducing costs.
Strikingly similar to the 2013 study findings, the 2014 study reflects an industry facing critical hurdles, many of which are not getting better. Based on 70-plus data points from over 400 claims leaders, the 2014 results further quantify how claims organizations focus resources to address these substantial hurdles.
2013 Report Summary
Claims Leaders participated in a nationwide survey about some of their most pressing daily operational challenges. Their survey results provide a look into how claims peers are addressing current industry priorities and hurdles. The 2013 Report – with perspectives from manager, director and executive-level claims professionals – presents findings in these key areas:
- Prioritizing Core Competencies
- Measuring Best Practices
- Incentivizing Operational Excellence
- Training & Retaining Staff
- Assessing the Impact of Technology & Data
- Evaluating Medical Performance Management
To learn more about the study program and the industry leaders involved, please click here.