April 2015 – Bridging the Gap between Research and Practice in Claim Management

Recently there has been significant progress in understanding the reasons why people become disabled after an injury or illness, as well as the predictors of return to work from disability.

Dr Marc Milot commented “Human behavior is now understood beyond the narrowly defined and deterministic biomedical model focused on the physical and pathophysiological aspects of illness.” In other words we now understand more about the link between a physical condition and the psychological impact of that condition. The general consensus is that the medical condition itself and the associated clinical outcomes provide limited insight and explain only a small part of claimant outcomes, including time taken to return to work.

Psychosocial factors, coping strategies, available resources, and workplace constraints are just a number of examples of dimensions not captured by a medical diagnostic code, but which strongly predict return to work and other claimant outcomes. These findings have emerged largely from academic research, and not from activities within the insurance industry where there continues to exist a research-practice gap.

There is a need to integrate research practices into claim analytics to better inform claim management. “For The Claim Lab this means we build our services and development of modeling tools on evidence-based practice, deploying research knowledge and techniques not familiar to industry data analysts and actuaries.”

“When you’re finished changing, you’re finished.” B. Franklin

For more information email us at info@claimlab.org