Psychosocial Issues Main Barrier to Successful Workers’ Comp Claims Outcomes

Claims leaders rank psychosocial issues as the number one barrier to successful claim outcomes, according to Rising Medical Solutions’ 2016 Workers’ Compensation Benchmarking Study survey.

A new white paper, co-authored by study program director Rachel Fikes and industry journalist Peter Rousmaniere, shows how claims advocacy principles at The Hartford, CNA, Nationwide, and Albertsons Companies are taming the effects of psychosocial issues and coaching injured workers to recovery and claim resolution.

The short report – “How to Overcome Psychosocial Roadblocks: Claims Advocacy’s Biggest Opportunity” – examines key best practices, skill sets and training approaches organizations are using to screen for, intervene in, and effectively address psychosocial factors. Rooted in advocacy, these strategies treat the injured worker as a whole person to proactively resolve non-medical barriers to timely recovery.

According to the report, psychosocial issues don’t relate to psychiatric issues, but rather to behavioral issues, like fear of moving an injured limb because of the associated pain. The report noted that The Hartford’s text mining found the presence of “fear” in claim notes was more predictive of poor outcomes than a lumbar fusion surgery.

Screening is one way to uncover potential psychosocial issues, according to the report.

“The negative impact of personal expectations, behaviors, and predicaments that can come with the injured worker or can grow out of work injury drive up claim costs far more than catastrophic injuries,” says Fikes. “Through this examination, one can see how adversarial, compliance, and task-driven claim styles are ill-suited for addressing the fears, beliefs, and perceptions of this distressed population.”

Benchmarking Study results confirm that a shift from traditional claim processing styles to advocacy-based styles is more prevalent in higher performing claims organizations. The 2016 Study also confirmed that greater training for claims adjusters in communication and soft skills, like empathy, is associated with higher performers.

Source: Rising Medical Solutions