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Insurers: Should you intervene in your claimant’s recovery?

By Graham Newman, Product Marketing Manager

Insurers: Should you intervene in your claimant’s recovery?

Excellence in customer service is a top priority for most insurers today, with all insurers aware of the importance of serving their customers as best they can to remain competitive. But how far can customer service extend? Should great customer service extend to intervening and aiding in a claimant’s recovery, shortening their claim duration and speeding their return to work? Or is that someone else’s job?

There is a feeling that all the claimant wants to hear from their insurance company after a reported injury or sickness is that their income is being protected and that money is on its way. So there is a worry that hearing from the insurer for any other reason may set off alarm bells and add stress to an already stressful situation.

While they certainly need to have that financial reassurance, they also want to recover and get their lives back on track as soon as possible. Insurers are in a unique position to help contribute to that process. In fact, early intervention with claimants benefits all stakeholders in the process – the claimant, the employer and the insurer.

  • For the claimant, the sooner they return to work, the more likely they are to fully recover. Return to work, or remaining in work, is highly beneficial to mental and physical well-being. “Work: the most effective means to improve well-being of individuals, their families and their communities”. [i]
  • For the employer, a better outcome reduces the time employees are off work, mitigating disruption and cost and easing workload planning
  • For the insurer, the fewer claims they have to actively manage, the better, and reducing the length of disability or sickness claims can significantly lower the indemnity spend and free up reserves. These savings can be significant; we have examples of clients who have taken tens of millions of dollars out of their actuarial reserves after focusing on improving claims outcomes.

But when and how should the insurer intervene? Insurers have at their fingertips a wealth of data to use in deciding which claimants may require extra help and at what point in time that help should be given. Enhancements to that data, including the claimant’s personal circumstances, attitudes toward recovery and socio-demographic information, can aid insurers in making accurate predictions of claim duration, and specifically, help them pinpoint which cases could benefit most from early-intervention.

The extent of their intervention is then subjective. It is up to the claims manager to apply their art to the situation to ensure the claimant is back on the road to recovery as soon as possible. In the majority of situations, this may be relatively simple. For example, they may find that a person is having trouble making it to doctor’s appointments, so they ensure that transportation arrangements are put into place. Or perhaps in some cases, it would be easier to arrange for the provider to travel to the claimant. In a minority of cases, a full blown return to health plan may be required, which is tailored to the claimant’s specific situation.

Working with experts in the field and with claims organizations globally that process hundreds of thousands of claims, FINEOS has developed a range of advanced tools to facilitate this claims management approach:

  • Business rules to triage the claims appropriately
  • Predictive analytics to score the claims appropriately and regularly
  • Service profiles to ensure same day claims payments
  • Operational analytics to react to changes in claim profiles
  • Omni-channel collaborative digital platform
  • Return to health planning tools

If you would like to find out more, take a look at our video on Better Claimant Outcomes.

[i] Waddell G, Burton K. Is work good for your health and well-being? TSO, London 2006