Automation builds trust & improves workers' comp claim outcomes

Workers’ compensation customers entrust their carrier to both take care of their injured employee and protect their company from financial harm. Each claim is unique, and workers’ comp claims adjusters often feel like they are expected to be jugglers or even magicians.

Service is the foundation of the claim process, spanning the core services a carrier provides to all customers, plus any specialized services purchased.

Compliance is paramount and complicated with workers’ compensation in the U.S. governed by state regulations that vary across a myriad of dimensions, from the timing of payments to communications.

Expense management matters, with adjusters following medical cost containment and modified duty programs. Litigated claims cost four times more and can take twice as long to resolve, with almost triple the number of lost time days.

Workers’ comp claims adjusters are relentlessly focused on achieving the best possible outcome for service, compliance and expense management. They become the glue that keeps the injured worker, and their manager focused on a common objective — for the employee to return to work as safely and quickly as possible. Adjusters must be compassionate and disciplined, making sure every compliance “i” is dotted and every service “t” is crossed, all while keeping the channels of communication open with both the injured employee and their manager.

In speaking with our customers now, the goals and challenges of workers’ comp claim adjusters remain virtually the same, despite the passage of time. Hearing they were making six outbound phone calls to an employee, with up to three weeks to connect for a return-to-work update, I thought to myself, “That was me — more than 30 years ago!” Except, my only alternative to calling was to show up, unannounced, at their home. It felt invasive and not conducive to getting a new relationship off to a great start. The last thing I wanted to do was trigger mistrust, the leading reason for attorney involvement.

Using technology, that customer can now reach out for updates using SMS, receiving information within an hour and with 35% fewer inbound calls. This translates to operational savings and prevents claim overpayments. Injured employees signaled their satisfaction both by opting-in and providing an 85% CSAT response.

The quality of the workers’ comp claim experience influences the quality of its outcome. The claim journey is a series of many critical and often predictable interactions, beginning with the report of the new injury.

Some workers’ comp first reports arrive as email attachments — sent via email, or the output of a fax server or transmitted from an agent’s system. Assigning more employees to monitor shared email boxes eventually hits the law of diminishing returns. And then, there is still the review and data entry to get each new claim into the claim system and the hands of the adjuster. Tick tock — the worried injured employee has no idea what to do, while the customer is counting on their carrier to begin handling the claim immediately.

Always assume that no one understands the claims process except a claims professional. If I were the injured employee, my anxiety level would drop substantially if, as soon as my manager reported my injury, I received an SMS from the insurance carrier saying, “We’re here — we’ve got you.” A spark of trust would emerge through the transparency of the workers’ comp carrier explaining the claim process, timeline and benefits calculation to me in layperson’s terms. My confidence in a wholly unfamiliar carrier (and my employer who selected them) would improve through access to resources, like a medical provider network or telemedicine provider. I would appreciate the speed and ease of e-signing a medical authorization. I would feel empathy through the option to schedule a call with my claims adjuster. The carrier could wrap up their first proactive outreach being sure I understand what happens next and when. Plus, the carrier would only be a hashtag away for any questions I might have in the interim.

Ripe for automation

The speed of interactions with the customer matters, too. It tells them, “We’ve got this — you and your employee are in great hands.” Requesting a wage statement is critical, predictable, “automatable,” and where speed also matters. Any instance when you can avoid paying workers’ comp benefits based on an estimated average weekly wage, the better. I remember frustrated injured worker calls when I could hear mistrust in their voice, doubting their benefit rate would ever be corrected, let alone soon.

There are other key stakeholders with critical and predictable interactions that are high-value candidates for automation to ensure they always happen quickly and efficiently. This could include sending an email to the treating physician, attaching the earlier e-signed medical authorization, requesting the ever-important confirmation of disability and any return-to-work target date.

We consistently discover that when a carrier examines the highest driver of inbound phone and email inquiries, claim status requests are at, or near, the top. One of our customers began sending out regular proactive claim status updates via SMS and saw their inbound call volume drop by 35%, while claimants reported 85% satisfaction.

Remember the regulatory compliance and service agreements mentioned earlier? Those too could include high-value interactions to automate — after all, they are critical and predictable.

With many opportunities to automate critical and predictable workers’ comp claim interactions, this is not about eliminating the person-to-person interactions that are always needed and highly valued. Rather, it’s about meeting the growing expectations of people of all generations and offering the option of digital self-service. With research showing that almost two-thirds of people will pick self-service first, automation creates capacity for claims adjusters to be more available for those conversations where the human touch is preferred and irreplaceable.

Imagine the positive impact on the daily experience of your workers’ comp claims adjusters — who are no longer making those six outbound phone calls — or perhaps showing up at someone’s home, unannounced.

Meredith Barnes-Cook is the global head of insurance at Ushur.

Opinions expressed here are the author’s own.

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• Going digital: You did it for claims – you can do it for enrollment, too
• How not to build a digital insurance platform