Mark Daniels - Gallagher Bassett

PERSONAL INJURY GETS PERSONAL: WORKERS’ COMPENSATION IN 2017

Mark Daniels - National Business Development Manager, Strategic Sales

AGENDA

2

Evolving social and cultural factors–community expectations

Grounds for change to the claims agent’s role

Review of the operational implications

Summary

EVOLVING SOCIAL AND CULTURAL FACTORS


4

Mental

Injury

Impact of

technology Occupational

Violence

Increase in reports of bullying and related

incidents in the workplace-noteworthy

sectors

WFH/’telecommuter’ /

’digital nomad’

Social media immediacy

Technology in motor

vehicles

Increases in hospitals,

schools, welfare sector

5

• Employers adopting a public stance on

prevention and support

• The retirement age – aging workforce

• ‘New’ jobs and vocations – remote working

• The ‘new workforce’ – the millennials

perspective


MENTAL INJURY – A CLOSER LOOK

6

Increase in individuals

prepared to speak out

Compare with those who

spoke out 10 years ago –

whole of community, AFL

players, politicians

Significant increase in

community acceptance

Individuals now

encouraged to speak out

MI a work and non-work

injury

Occupation based vs

workplace based

Broader community

support has implications

Bullying legislation-Brodie’s

Law-2011-10 years

imprisonment

Addressing “loss of control”-

NDIS

MENTAL INJURY – A CLOSER LOOK

7

Employers adopting public

position and offering support

CEO’s speaking out and implementing

prevention initiatives

2016 Cotton Report – “how do we best

deliver wellbeing services to support employees

throughout their career and into their post –

Victoria Police lives” – Chief Commissioner

Graeme Ashton

Recent review at MFB

Establishment of organisations dedicated

to support people who speak out

Formalised EAP and support processes in

education, health, aged care sectors

Lifeline / Beyond Blue

Worksafe Advisory Service

IMPACT OF TECHNOLOGY – A CLOSER LOOK

8

4 MILLIONWFH workers in the UK

2.8%OF US WORKFORCE

WFH/50% WFH ENABLED

• The advent of the ‘telecommuter’ / ‘digital

nomad’ / WFH

• Blurring of work/life roles and definition of

‘workplace’

• Lack of a commute allows ‘over work’

• Immediacy and impact of social media-

Change.org

• Accelerated ‘take up’ rate

• Millennials – native to technology

9

THE STATISTICS – AN OVERVIEW

Physical injury –remains largest

sector - steady decline

Recent reduction in serious injuries

Number of MI claims in recent years

– the increase is material

Increased litigation and settlements

THE REGULATOR’S ROLE

• Ongoing focus on continuous improvement

• Ensure the system is fair, efficient and affordable

• Deliver on the objective of reduced claim

volumes and improved claim outcomes

• Respond to emerging societal trends

10

THE IMPACT

11

• Significant challenge/opportunity for WorkSafe, claims agents and

employers

• WC legislation is highly proscriptive, complex and frequently amended

• Changed community values present challenges for any inherently

adversarial or traditionally hierarchical process and culture

• Simply stated: claims management practices must reflect community

expectations while remaining compliant with statutory obligations

• Practices, comms, look and feel

GROUNDS FOR CHANGE TO THE CLAIM AGENT’S ROLE

13

CHANGES TO THE CLAIM AGENT’S ROLE

Service models

must cater

for changed

community values

and behaviours

• Focus on broader wellness programs pre

claim

• Engage and assist employers to change

approach

• Seek out employer feedback

• Specific risk management programs –

education, aged care

• Greater diversity in service models

• More flexibility and support for the different

needs of injured workers

REVIEW OF OPERATIONAL IMPLICATIONS

OPERATIONAL IMPLICATIONS

15

• Less adversarial communications

• Review of case manager recruitment, training and development programs

• Enhanced triage and segmentation procedure

• Implementation of a broader wellness focus at all claims management

milestones

1. Pre-claim initiatives – prevention and containment

2. At lodgement – expectation management

3. Claim segregation - fast track/complex

16

PRE CLAIM STRATEGIES

UNDERSTAND

Understanding pre

claim WC related

obligations and

commitments

IDENTIFY

Early identification

in the workplace –

early signs

EDUCATE

Specific training

programs –

“managing stress”,

“preventing and

responding to

bullying in the

workplace”

RESPOND

Appropriate initial

conversations with

all involved

MI claims often not

complex at start

17

CLAIM LODGEMENT STRATEGIES

EDUCATION

Early intervention

Prompt lodgement / triage

Understanding of

respective legislation

PROCESSES

Early intervention and

triage processes

‘set the tone” of

subsequent comms /

interactions

STAKEHOLDERS

Effective relationship with

eligibility officer

New role – Manager,

Sound and Proper

Decision Making

18

Characteristics

• ‘claims processing’ approach

• ‘open pay close’

• back office

• digital lodgement

• automated payments

• minimal human interaction required

FAST TRACK SERVICE MODEL

COMPLEX CLAIMS SERVICE MODEL

19

Characteristics

• more claims require increased support and management intervention

• the traditional case management approach may not be appropriate

• increased emphasis on broader wellness and overall support

• early mediation with involved parties

• managed communication expectations

• collaborative, targeted contact with the treating doctor

• reduction in frequency of ‘unnecessary’ contact and investigations

Characteristics

• promotion of the worker/employer relationship

• review of legislation and communication between the

worker and case manager

• review of the dispute model

• face to face support - mobile case management

• meet pre-decision to explain the process and options

• opportunity to assist with transition to different support

services

• assess available and appropriate government services

20


21


Case Manager Specialisation

• specialisation commenced and evolving

• on going, more sophisticated training e.g.. MI

• employer communication support

• demonstrated understanding of the injured worker needs

• carefully considered allocation of MI claims

• specialised portfolios with internal support mechanisms

• facilitation of less adversarial, more plain language communication style

• demonstration of less ‘process’ style approach

CHANGES TO THE CLAIM AGENT’S ROLE

22

Positive Indications

• approach implemented in March 2016 – evolving

• specialised portals and services

• less adversarial communications

• review of the dispute resolution process

• broad emphasis on quality decision making, worker and employer service delivery

• fewer complaints

SUMMARY

24

SUMMARY

• Community expectations have evolved requiring

changes in claims management philosophy and

strategy

• Requirement to provide a less adversarial approach

in the delivery of claim management services while

adhering to legislation

• CA’s / employer partnership s to provide broad

based prevention initiatives and feedback

• CA / WS partnership to facilitate changed approach

• Early indications are positive and encouraging

THANK YOU