Mark Daniels - Gallagher Bassett

  • Published on
    12-Apr-2017

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PERSONAL INJURY GETS PERSONAL: WORKERS COMPENSATION IN 2017Mark Daniels - National Business Development Manager, Strategic SalesAGENDA2Evolving social and cultural factorscommunity expectations Grounds for change to the claims agents role Review of the operational implications Summary EVOLVING SOCIAL AND CULTURAL FACTORSEVOLVING SOCIAL AND CULTURAL FACTORS4Mental InjuryImpact of technology Occupational ViolenceIncrease in reports of bullying and related incidents in the workplace-noteworthy sectors WFH/telecommuter / digital nomadSocial 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 FACTORSMENTAL INJURY A CLOSER LOOK6Increase in individuals prepared to speak outCompare with those who spoke out 10 years ago whole of community, AFL players, politiciansSignificant increase in community acceptanceIndividuals now encouraged to speak outMI a work and non-work injuryOccupation based vs workplace based Broader community support has implicationsBullying legislation-Brodies Law-2011-10 years imprisonment Addressing loss of control-NDIS MENTAL INJURY A CLOSER LOOK 7Employers adopting public position and offering supportCEOs speaking out and implementing prevention initiatives2016 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 AshtonRecent review at MFBEstablishment of organisations dedicated to support people who speak outFormalised EAP and support processes in education, health, aged care sectorsLifeline / Beyond BlueWorksafe Advisory ServiceIMPACT OF TECHNOLOGY A CLOSER LOOK 84 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 9THE STATISTICS AN OVERVIEW Physical injury remains largest sector - steady decline Recent reduction in serious injuriesNumber of MI claims in recent years the increase is materialIncreased litigation and settlementsTHE 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 trends10THE IMPACT11 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 ROLE13CHANGES 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 IMPLICATIONSOPERATIONAL 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 containment2. At lodgement expectation management 3. Claim segregation - fast track/complex 16PRE CLAIM STRATEGIESUNDERSTANDUnderstanding pre claim WC related obligations and commitmentsIDENTIFYEarly identification in the workplace early signsEDUCATESpecific training programs managing stress, preventing and responding to bullying in the workplaceRESPONDAppropriate initial conversations with all involvedMI claims often not complex at start 17CLAIM LODGEMENT STRATEGIES EDUCATIONEarly interventionPrompt lodgement / triageUnderstanding of respective legislationPROCESSESEarly intervention and triage processesset the tone of subsequent comms / interactionsSTAKEHOLDERSEffective relationship with eligibility officerNew role Manager, Sound and Proper Decision Making18Characteristics claims processing approach open pay close back office digital lodgement automated payments minimal human interaction required FAST TRACK SERVICE MODELCOMPLEX CLAIMS SERVICE MODEL 19Characteristics 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 20COMPLEX CLAIMS SERVICE MODEL21COMPLEX CLAIMS SERVICE MODELCase 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 22Positive 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 SUMMARY24SUMMARY 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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