Mark Daniels - Gallagher Bassett

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    12-Apr-2017

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  • PERSONAL INJURY GETS PERSONAL: WORKERS COMPENSATION IN 2017

    Mark Daniels - National Business Development Manager, Strategic Sales

  • AGENDA

    2

    Evolving social and cultural factorscommunity expectations

    Grounds for change to the claims agents role

    Review of the operational implications

    Summary

  • EVOLVING SOCIAL AND CULTURAL FACTORS

  • 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

    EVOLVING SOCIAL AND CULTURAL FACTORS

  • 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-Brodies

    Law-2011-10 years

    imprisonment

    Addressing loss of control-

    NDIS

  • MENTAL INJURY A CLOSER LOOK

    7

    Employers adopting public

    position and offering support

    CEOs 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 REGULATORS 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 AGENTS ROLE

  • 13

    CHANGES TO THE CLAIM AGENTS 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

    COMPLEX CLAIMS SERVICE MODEL

  • 21

    COMPLEX CLAIMS SERVICE MODEL

    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 AGENTS 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

    CAs / 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

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