Absence Management

Technology’s Role in Managing Employee Absences

Tools are available to help employers improve claim intake, workforce planning, clinical care and return-to-work strategies.
By: | October 5, 2015 • 5 min read

The 24th annual National Workers’ Compensation and Disability Conference® and Expo takes place Nov. 11-13 at the Mandalay Bay Resort and Casino in Las Vegas. The conference is produced by LRP Publications, which publishes Risk & Insurance®. For more information, visit www.wcconference.com.

You might not think that an employee’s absence for just a few days could raise concern for an employer. But all absences are not created equally.


There is workers’ comp, short- and long-term disability, Family and Medical Leave Act, and other types of absences. Some are planned, others are not. Some are paid, some unpaid. Some are associated with job protection benefits, others are not. There are state and federal regulations that may apply.

Employers need to understand when each should be employed and make sure they have fair and consistent practices in administering their leave programs.

“There is a misconception that absence management is easy. It is not,” said Keith Nelson, vice president and head of group insurance program delivery for Aetna Life Insurance Co. “Absence management is very complex.”

As Nelson explains, even a single day of absence may involve multiple types of leave and can impact different components of an organization in many different ways.

“We’ve got state mandated leaves such as those under workers’ comp, and state family and medical leave laws, that run concurrently with FMLA leaves,” he says. “There are now even a growing number of municipal leaves being added into the equation for employers to administer.”

WCconf_24thAnnualNelson will discuss the complexities of leaves and how employers can use technology to improve claim intake, workforce planning, clinical care, and return-to-work strategies.

His session, Technology Tools for Managing Disabilities and Absences, takes place Thursday, Nov. 12 from 10:45 a.m. to noon.

Effects on Personnel

“An employee might be out for one day, but that day of absence could apply to 15 or 16 different benefits,” Nelson said.

“Some have different start dates or end dates. The employee may have been approved for one benefit but denied for another on the same day. In my experience, many key stakeholders don’t fully understand those nuisances. There’s a concurrency component of absence management.”

An employee’s absence may affect people within an organization differently, depending on the role of the person. Each may have a different awareness of which type of leave benefit applies to the employee’s absence request.

“An employee might be out for one day, but that day of absence could apply to 15 or 16 different benefits.” — Keith Nelson, vice president and head of group insurance program delivery, Aetna Life Insurance Co.

“From the employee’s perspective, they don’t know all the benefits available to them or the differences,” Nelson said. “The only thing some of them can say is ‘I’m injured or ill,’ whether it happened at work or not, and ‘I need to be off of work.’”

Absence, he explains, is very personal to each individual. The concerns change from one person to another throughout the company.

“As you go up the organization, the interests are very different,” he said. “For the supervisor, it is ‘do I have a full staff at work?’”

Plant managers, human resources personnel, and the company’s CEO all have other concerns about an employee’s absence. Where one department is concerned about the effects on productivity, another may be more interested in finding out how and why the injury/illness occurred.

“Employers want to protect their employees from injuries or safety incidents. They are really all about mitigating safety risks and putting prevention in place,” Nelson said. “From the economic side of a workers’ comp accident, not only is the employer funding the lost wages for an employee who is away from work, but also likely funding the legal expenses, the medical expenses, and all kinds of claim-related expenses such as temporary labor expenses.”

“Different rules of compensability apply in different states. Moreover, employers may offer different types of disability plans for different groups of employees,” Nelson said. “The same can be said for leave of absence policies that are offered to different groups of employees. The overarching impact is the same: ‘Do I have a full workforce or not?’”

The one common link among each department is the need for information about the absence.


With technology, each department within an organization has access to information about an employee’s leave in the form best applicable to the needs. Personnel can better understand the overall picture of absences with a good technology platform.

“It enables effective information exchange,” Nelson said. “There is a whole new level of sophistication in the workforce, and employers/providers have a new appetite for information. That’s the big picture of what the session is all about — learning how technology can assist employers to administer effective absence management programs.”

Employers are required to use fair and consistent practices when applying the various types of leaves. Through technology, various facets within an organization can have a clear understanding of the rules and regulations.

“The industry is changing,” Nelson said. “There are new regulations all the time, new types of benefits, emerging paid sick and paid family leave. From a workers’ comp perspective, there is medical only and true lost time claims, but it’s still the same individual. How does it work? How do all constituents stay informed?”


The privacy aspect of an employee’s absence is another concern that can be addressed through technology. For example, workers’ comp has different protocols for sharing claim information than is routinely used for disability and state or federal leaves. The circumstances dictate what can be shared with an employer.

Failing to ensure fair and consistent practices can lead to regulatory scrutiny, legal action, and other financial liability. Technology can help reduce the complexities of absence management, minimize inconsistencies, and ultimately, mitigate risks.

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]
Share this article:

2015 NWCDC Preview

Session Offers Valuable Lessons Through Unusual Cases

Workers' comp attorney and author Thomas Robinson will explore a selection of shocking workers' comp claims at this year's NWCDC, and explain what practitioners can learn from these cautionary tales.
By: | September 14, 2015 • 4 min read
Topics: Claims | NWCDC | Workers' Comp
Beautiful woman working at the computer

The 24th annual National Workers’ Compensation and Disability Conference® & Expo takes place Nov. 11-13 at the Mandalay Bay Resort and Casino in Las Vegas. The conference is produced by LRP Publications, which publishes Risk & Insurance®. For more information, visit the NWCDC website.

Have you heard the case about the overweight worker who pulled a helicopter too close to the ground and sustained injuries as he bumped along? It involved a worker tethered to a helicopter with only a rope tied around his waist as he tried to catch deer to bring to a company’s out-of-state property for hunters.


“The employer denied the claim claiming, among other things, that he was an independent contractor,” said Thomas A. Robinson, J.D. and coauthor of Larson’s Workers’ Compensation Law. “He prevailed in the end, but it’s an example of the expression, what are the good old boy’s last words? ‘Watch this!’”

It’s just one of many bizarre workers’ comp cases Robinson has seen during his decades as a workers’ comp attorney and author. The cases form the basis of Robinson’s session at this year’s conference.

Even though the cases are bizarre (and in some cases humorous), Robinson says there are also valuable lessons for practitioners.

Arthur Larson Connection

Robinson’s interest in unusual workers’ comp cases can be traced to the start of his career when he worked for one of the icons of the industry. While he was attending graduate school at Duke University in the 1980s, Robinson worked part time for Arthur Larson.

A one-time undersecretary of Labor and law professor emeritus at Duke University, Larson is credited with writing one of the most comprehensive and authoritative treatises in the workers’ comp industry. Robinson said the two became friends.

“Starting around 1989, we’d gather for cocktails at his house in early January. All through the previous year we’d each keep a list of bizarre cases, and in January we’d sit down and compare our cases.”

“This sounds hokey, but all too often the employer and the employee seem to check their supply of common sense at the door.” — Thomas A. Robinson, J.D., coauthor of Larson’s Workers’ Compensation Law

Fast forward to early this century, Robinson said he became nostalgic about the annual session with Larson. “I’m going to do my own bizarre list each year and raise a glass to Arthur,” he explained. “I sent the list out to a group of folks for a number of years.”

Eventually, Robinson turned his annual list into a blog. “About three years ago, National Public Radio picked it up and used it for a Saturday morning broadcast,” he said. “That helped move it along. Now it’s actually the most popular annual blog for the LexisNexis workers’ comp site.”

Lessons to Learn

Robinson reminds his audiences that even though ‘we are having some fun with this … for some people these were real cases and the fact that they are bizarre doesn’t take away from the fact that someone got hurt.” The session “takes advantage of the fact that by its nature workers’ comp law generates a whole number of interesting, quirky, bizarre cases in any given year.”

Robinson said he finds cases ripe for the blog and the session by skimming through approximately 2,500 workers’ comp cases annually. Some are also sent to him by interested readers.

One case involved what Robinson said was an “immature” EMT trying to impress a female colleague by using cardiac paddles on her. “He activated the paddles and killed her,” he said. “Things like this happen within the workplace and that’s what produces this stuff.”

Many of these cases involve horseplay among workers as well as alcohol. And many can be anticipated and prevented by employers, Robinson said.


“This sounds hokey, but all too often the employer and the employee seem to check their supply of common sense at the door,” he explained.

Robinson said he has a plethora of bizarre cases, along with advice for attendees. While the session will include the 10 bizarre cases of 2015, he said he might also add some of those he shared with Larson.

“Because it’s the first time [doing this session] in Las Vegas, I actually might save a couple of spots for my all-time favorites,” he said. “I’ve got cases going back 25 years. I may show several from prior years.”bizarre_sidebar.indd

Nancy Grover is the president of NMG Consulting and the Editor of Workers' Compensation Report, a publication of our parent company, LRP Publications. She can be reached at [email protected]
Share this article:

Sponsored Content by ACE Group

6 Truths about Predictive Analytics

ACE's predictive analytics tool provides a new way to capture, analyze and leverage structured and unstructured claims data.
By: | October 1, 2015 • 6 min read

Predictive data analytics is coming out of the shadows to change the course of claims management.

But along with the real benefits of this new technology comes a lot of hype and misinformation.

A new approach, ACE 4D, provides the tools and expertise to capture, analyze and leverage both structured and unstructured claims data. The former is what the industry is used to – the traditional line-item views of claims as they progress. The latter, comprises the vital information that does not fit neatly into the rows and columns of a traditional spreadsheet or database, such as claim adjuster notes.

ACE’s recently published whitepaper, “ACE 4D: Power of Predictive Analytics” provides an in-depth perspective on how to leverage predictive analytics to improve claims outcomes.

Below are 6 key insights that are highlighted in the paper:

1) Why is predictive analytics important to claims management?

ACE_SponsoredContentBecause it finds relationships in data that achieve a more complete picture of a claim, guiding better decisions around its management.

The typical workers’ compensation claim involves an enormous volume of disparate data that accumulates as the claim progresses. Making sense of it all for decision-making purposes can be extremely challenging, given the sheer complexity of the data that includes incident descriptions, doctor visits, medications, personal information, medical records, etc.

Predictive analytics alters this paradigm, offering the means to distill and assess all the aforementioned claims information. Such analytical tools can, for instance, identify previously unrecognized potential claims severity and the relevant contributing factors. Having this information in hand early in the claims process, a claims professional can take deliberate actions to more effectively manage the claim and potentially reduce or mitigate the claim exposures.

2) Unstructured data is vital

The industry has long relied on structured data to make business decisions. But, unstructured data like claim adjuster notes can be an equally important source of claims intelligence. The difficulty in the past has been the preparation and analysis of this fast-growing source of information.

Often buried within a claim adjuster’s notes are nuggets of information that can guide better treatment of the claimant or suggest actions that might lower associated claim costs. Adjusters routinely compile these notes from the initial investigation of the claim through subsequent medical reports, legal notifications, and conversations with the employer and claimant. This unstructured data, for example, may indicate that a claimant continually comments about a high level of pain.

With ACE 4D, the model determines the relationship between the number of times the word appears and the likely severity of the claim. Similarly, the notes may disclose a claimant’s diabetic condition (or other health-related issue), unknown at the time of the claim filing but voluntarily disclosed by the claimant in conversation with the adjuster. These insights are vital to evolving management strategies and improving a claim’s outcome.

3) Insights come from careful analysis

ACE_SponsoredContentPredictive analytics will help identify claim characteristics that drive exposure. These characteristics coupled with claims handling experience create the opportunity to change the course of a claim.

To test the efficacy of the actions implemented, a before-after impact assessment serves as a measurement tool. Otherwise, how else can program stakeholders be sure that the actions that were taken actually achieved the desired effects?

Say certain claim management interventions are proposed to reduce the duration of a particular claim. One way to test this hypothesis is to go back in time and evaluate the interventions against previous claim experience. In other words, how does the intervention group of claims compare to the claims that would have been intervened on in the past had the model been in place?

An analogy to this past-present analysis is the insight that a pharmaceutical trial captures through the use of a placebo and an actual drug, but instead of the two approaches running at the same time, the placebo group is based on historical experience.

4) Making data actionable

Information is everything in business. But, unless it is given to applicable decision-makers on a timely basis for purposeful actions, information becomes stale and of little utility. Even worse, it may direct bad decisions.

For claims data to have value as actionable information, it must be accessible to prompt dialogue among those involved in the claims process. Although a model may capture reams of structured and unstructured data, these intricate data sets must be distilled into a comprehensible collection of usable information.

To simplify client understanding, ACE 4D produces a model score illustrating the relative severity of a claim, a percentage chance of a claim breaching a certain financial threshold or retention level depending on the model and program. The tool then documents the top factors feeding into these scores.

5) Balancing action with metrics

ACE_SponsoredContentThe capacity to mine, process, and analyze both structured and unstructured data together enhances the predictability of a model. But, there is risk in not carefully weighing the value and import of each type of data. Overdependence on text, for instance, or undervaluing such structured information as the type of injury or the claimant’s age, can result in inferior deductions.

A major modeling pitfall is measurement as an afterthought. Frequently this is caused by a rush to implement the model, which results in a failure to record relevant data concerning the actions that were taken over time to affect outcomes.

For modeling to be effective, actions must be translated into metrics and then monitored to ensure their consistent application. Prior to implementing the model, insurers need to establish clear processes and metrics as part of planning. Otherwise, they are flying blind, hoping their deliberate actions achieve the desired outcomes.

6) The bottom line

While the science of data analytics continues to improve, predictive modeling is not a replacement for experience. Seasoned claims professionals and risk managers will always be relied upon to evaluate the mathematical conclusions produced by the models, and base their actions on this guidance and their seasoned knowledge.

The reason is – like people – predictive models cannot know everything. There will always be nuances, subtle shifts in direction, or data that has not been captured in the model requiring careful consideration and judgment. People must take the science of predictive data analytics and apply their intellect and imagination to make more informed decisions.

Please download the whitepaper, “ACE 4D: Power of Predictive Analytics” to learn more about how predictive analytics can help you reduce costs and increase efficiencies.


BrandStudioLogoThis article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with ACE Group. The editorial staff of Risk & Insurance had no role in its preparation.

With operations in 54 countries, ACE Group is one of the largest multiline property and casualty insurance companies in the world.
Share this article: