Short Term Disability

“There is not enough time to manage claims properly”

“Either they get better or they go to LTD”

“We have so many claims that we cannot hope to be proactive”

These are things we hear constantly, and The Claim Lab has a better idea, let’s focus claim managers on the claims that need to be managed, and leave others that are highly likely to return to work.

Our STD analysis techniques identify the claims that need attention, and suggest ways in which the claim managers can best handle these claims.

We look at claims that, for a given condition, are very likely to go to LTD. Also, we look for claims that have been open for too long for a particular diagnosis.

The diagram above shows the three classifications used to group STD claims:

Long Term Claim – This classification indicates that the analytics suggest this claim is serious and could become an LTD claim. The recommendation is therefore to manage the claim as if it were an LTD already, and apply all the interventions available to achieve a return to work.

Fast Path – This classification is for a claim that is on track for a return to work and for this diagnosis, and for a claimant in this situation, it is still within the expected return to work time. Therefore, no resources should be invested in this claim, it is ok. The claim should be placed on auto-pay for a period suggested by the analytics, or paid and closed.

Active Management – This is for a claim that was previously in the “Do Not Touch Category” but has now gone beyond that normal return to work time. The assumption is that there must be a complicating factor, and the claims needs further investigation and active management from here on.

Short Term Disability – Reporting

The Claim Lab will produce two types of report. First, there is a new claims report that shows in which classification a newly reported claim has been placed. Secondly, there is an exception report to highlight claims that have not followed the expected path. For example, for STD claims this would be claims that are now in the “Action Required” classification, and need to be actively managed. There can be many reasons for this (condition is more severe than expected, there is a secondary diagnosis, even malingering by the claimant) but these claims need to be highlighted for investigation.

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