April 2019 – Chili Sause!

Last month we started a series of newsletters (February) to introduce the concept of data enrichment of claims information and we discussed how this will help us to understand what’s really preventing return to work for complex claims.

Maybe for those short term disability plans of 3 to 6 months, the duration is driven by diagnosis. In the healthcare industry recovery is measured over a 6 month period. So by its very nature a claim that has gone on longer than 6 months has complications….

We have been told for many years in the claims world that we should not over medicalize claims, yet when claim managers get stuck, they order an IME!

We know that the likelihood is that there is something else going on: work issues, poor motivation, anxiety, depression, domestic issues, medication dependence, etc. on top of the primary diagnosis.

These are the psychosocial factors, that after the first few months of a claim, should really be driving our claim management process.

An experienced claim manager could, probably after 7 mins on the phone, start to dig into some of these issues, BUT we don’t have many experienced claim managers any more, and if we do, their case loads are too high, and new claim managers are lacking the required skills.

Just imagine for a moment, that we had developed a way of understanding these psychosocial influencers without the need for an experienced claim manager!

What if we had a tool that could capture and quantify these psychosocial issues?
In a reliable, consistent, and measurable way.
That would be pretty cool!

A tool that will help a claim manager understand the heart of the problem with such a claim.
The effect would be like adding Chili-Sauce to Claim Management….
A number of people warned us that this could not be done.

Yet in Australia, for managing workers compensation claims, they swear by the psychosocial factors. They can’t see how you can manage a claim effectively without collecting this information.

We have taken their guidance, with a good ‘dollop’ of predictive modeling technology, and started applying the same techniques to disability insurance claims. We are now working with insurers in Canada, the US and Australia on such projects, and are getting help and support from a worldwide Re-insurance company.

This is a new way of working and represents real innovation in the disability claims industry.

We are seeing more effective telephone interviews, improved use of interventions, a better understanding of the individual’s barriers to return to work, an improved customer experience, and collection of quality data for analytics.

We are looking for disability insurers in Canada, the US and Australia to help us with our pilot program, so if interested, please contact us for more details.

Email us at info@claimlab.org

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