Advocacy drives the Lumen Technologies workers' comp program

Browse any online news site or listen to a newscast and you’d be hard pressed not to find information about workers’ compensation issues. From dealing with exposures during the COVID-19 pandemic to concern over employees returning to work after an injury, many companies are doing what it takes to get back to “business as usual” while also safeguarding employees.

Lumen’s approach is unique because the company boasts a dedicated team member whose sole job is to listen to the employees, form relationships with them, be a resource for any issue they are having, and solve problems that are impacting the employee’s journey through the workers’ compensation system.

“The TLC that our advocate provides to the employees really decreases the confusion, aggravation and frustration our injured workers face,” Acton says.

In addition, Lumen created four custom predictive models as part of their workers’ compensation process. It was actually the company’s TPA that brought the idea of the four predictive models to Lumen because they know that Lumen is interested in new ideas to improve claim handling and reduce costs.

“We are lucky to have decades of data with our TPA so we could develop Lumen-specific predictive models,” Acton says. “Our geographic distribution is unique, so having our own data set really increased our confidence the models would benefit our program.”

Here’s how the company’s predictive modeling works: Once a claim hits any of the models, Lumen provides extra attention to specific areas of concern.

“Our Sedgwick national performance manager provides suggestions to the examiner to avoid the predicted outcome,” Acton says.

As the claim develops, the internal Lumen team and Sedgwick partner to monitor the claim and adjust the plan as necessary.

As Acton explains, the models help Lumen manage the files that truly need more intervention. While the technology behind the predictive models is powerful, it’s the marriage of technology with experience and exceptional claims handling skills that makes Lumen’s approach distinct.

“The models have been very successful and since 2015, we believe we have achieved a 9.09 to 1 ROI for the program,” Acton says.

Prior to embracing an advocacy-based claims model, Acton doesn’t think Lumen received much feedback from their employees except when the claims handling experience did not go well.

“We generally thought the outcome was the employee’s poor attitude or lack of following directions,” Acton says. “By having an advocate on the team who interacts with our claimants regularly, we learned so much from our employees about the process, pinch points, frustrations, and basically why they hire an attorney.” The company values employees feedback and takes into account each employee’s perspective as it refines and improves the program.

“Not all feedback is positive, but now we routinely get praise from our employees and their families regarding their claims examiners, the dedicated telephonic nurse case managers, our advocate and sometimes the overall process,” Acton says.

Centralized model

Another core component that sets Lumen’s workers’ compensation program apart is its focus on having a centralized claim examiner model.

According to Acton, for years Lumen’s model was to use examiners in each state in order to take advantage of their jurisdictional expertise. While Lumen gained someone who knew all the forms and rules in a given state, the company had many examiners who did not have many Lumen workers’ compensation claims on their desk.

“These examiners often did not know our client service instructions as well as we wanted, but more importantly, may not have shared our employee centric claim philosophy,” Acton says. “Knowing how much Lumen values examiners who share our claim philosophy, Sedgwick suggested that we could consolidate claims on a fewer number of desks.”

Lumen still has to have examiners in the resident adjuster states, but the company was able to reduce the number of claims examiners and create a dedicated team that handles the vast majority of Lumen claims.

As Acton explains, the dedicated team consists of claims examiners who understand what Lumen wants and provides a positive experience to employees throughout the workers’ compensation claim.

“We think having this model benefits our employees because the examiners know all the programs Lumen offers to assist employees in their recovery, and the examiners know Lumen jobs and lingo, so there is easy communication between our workers and the examiners,” Acton says. “Overall, we think the process moves more smoothly for everyone when you have expert examiners running the show rather than having an examiner who constantly has to switch between client service instructions.”

Acton says the next frontier for Lumen is to explore how to better address behavioral health (“BH”) comorbidities that often increase claim cost and claim duration.

“In workers’ compensation, however, BH is the area you don’t want to ‘buy,’ so we are always really careful about what we do and how we approach the topic,” Acton says. “Once we have better tools that help our workers with these issues, then I would like to find a way to identify the claimants who need the help before the costs and durations exceed normal expectations.”

See also:

• 2022 Workers’ Comp Award winners showcase adaptability (Part 1 of 3)
• TC Transcontinental Packaging fosters synergistic teamwork (Part 2 of 3)
• 2021 Workers’ Comp Risk Management Award