Predictive analytics in action

Leading workers' compensation carriers are establishing ways to take a more holistic approach to recovery. Questionnaire-based assessments and predictive analytics can help proactively identify potential risks and barriers to recovery. For example, at The Hanover, upon receiving the first notice of loss, a professional workers' compensation claims adjuster requests detailed data through a survey of the injured employee and their employer to identify claims in need of special handling to enable a more positive outcome. The survey delves into the employee's background, understanding their daily routines, social connections, and emotional state. By gathering this information early, an adjuster can proactively identify potential risks and barriers to recovery.

Armed with insights from the questionnaire, adjusters and nurse case managers can create personalized recovery plans to address individuals' unique needs. For instance, consider the case of a middle-aged man who fell down a ventilation shaft, sustaining a serious knee injury. Through the questionnaire, the claims team discovered that he lived alone and often felt lonely. This lack of social support could hinder his recovery. Due to this factor, a nurse case manager arranged homecare services and regular wellness visits, ensuring he received physical and emotional support during his recovery period.

Leveraging predictive analytics to assess risk levels and potential barriers enables better responses. By analyzing responses, insurers can identify patterns to help guide adjusters and nurse case managers in responding appropriately. This data-driven approach ensures timely interventions and tailored support for employees and the employer.

Strategies to overcome barriers

There are many barriers outside of physical ailments that can prevent employees from returning to work. For instance, psychosocial barriers—such as fear-driven avoidance, pain catastrophizing, and insufficient coping mechanisms—can significantly impact recovery. There are ways that carriers can help to address these barriers throughout the claims process to ensure the injured employee has the support they need for a successful recovery, including:

Engaging nurse case managers: Assigning dedicated nurse case managers to injured employees makes a significant impact. These professionals provide emotional support, answer questions, and guide individuals through the recovery process. By having a single point of contact, employees may feel more connected and understood.

Establishing clear Return-to-Work paths: Medical professionals can collaborate with employers to develop clear return-to-work plans. This involves aligning work opportunities with injury limitations, and gradually increasing to full duty as recovery progresses. Diligence during the transition back to work reduces the likelihood of delayed recovery and supports prompt return to productivity.

Providing empathy training: Working with specialists who undergo comprehensive training enables better support. These specialists learn to provide empathetic solutions and personalized recommendations. Acknowledging an employee's emotional state and showing understanding fosters trust and cooperation.

Insurance professionals have a unique opportunity to transform workers' compensation. By embracing holistic care, predictive analytics, and empathy, we can empower employees to recover fully and return to work with confidence. When workers' compensation is a supportive partnership—one that meets employees where they are, both physically and emotionally – everyone wins. To learn more about taking a holistic approach to workers' compensation please click here.