Fixing the most common pain point in workers’ comp claims

Fixing the most common pain point in workers’ comp claims | Insurance Business

Fixing the most common pain point in workers’ comp claims

Injured workers typically have little to no prior experience with workers’ compensation claims. When their employer files a claim on their behalf, many have concerns around how their medical care will be managed, who will pay for that care, and how any medical leave might impact their wages or employment status, among other things.

“One of most common pain points in workers’ compensation claims is communication,” said Brent Bland, senior vice president and head of workers’ compensation claims, AmTrust Financial Services. “There’s a general lack of understanding among injured workers of how the workers’ compensation claims process works. I think one of the biggest challenges for our industry is in the area of communication and helping people understand from the very beginning what workers’ compensation is intended to cover and what help they should expect to receive if they suffer an on-the-job injury.”

Communication is never a one and done thing. While it’s important for insurers to help injured workers to understand at the onset of a claim what benefits they’re entitled to under workers’ compensation, it’s equally (if not more) important for insurers to keep the lines of communication open and be engaged throughout the lifecycle of the claim in order to alleviate any concerns that may arise.

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“A big part of our portfolio at AmTrust is small business,” said Bland. “If they’ve had prior experience with workers’ compensation claims, it’s usually very limited. We put a lot of time and effort into educating our insureds so that they have a good clear understanding of the process, and they can relay that information to their employees. It’s critical that the employer-employee relationship is maintained through the lifecycle of a claim. One of the worst things that can occur is for there to be a breakdown in communication between the employer and employee. That can generate a lack of trust, lack of understanding, and it can create some real challenges.”

One of the services that AmTrust offers through workers’ compensation is a nurse triage program. From the onset of a claim, injured workers have access to a registered nurse who will triage their injury and connect them with a healthcare provider who understands workers’ compensation and will give them the right level of care. Injured workers can also reach out to AmTrust’s nurses for information and support throughout their claim.

“We utilize our nurses to be that advocate, that support and that resource, so that injured workers are not looking externally for help. When there are unknowns, that’s when you’ll see injured workers looking to attorneys to get additional questions answered,” said Dr. Melissa Burke, vice president, head of Managed Care and Clinical for AmTrust Financial Services. “At AmTrust, we focus on a patient-centered approach where we practice active listening, we let injured workers tell us what they need, we provide the required information and resources, and we work with them to find the best solution for their unique needs. It’s a two-way street. Communication is key.”

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In recent years, customers have grown to expect far more personalized communication from their insurance brokers and carriers, according to Burke. Injured workers want bespoke service, and they want multiple options for how to interact with insurers, whether that’s through phone calls, text messaging, email, in-person meetings, or video consultations. But most importantly, they want an immediate response to any queries they may have.

“There’s a general expectation on the part of injured workers and our insureds that when they do have questions or concerns, there’s a timely response that is comprehensive and allows them to move on their way,” Bland told Insurance Business. “I think that technology has changed expectations of timeliness, and I don’t think those expectations are unreasonable. We all have tools available to use that enable us to meet those expectations.”