Veteran stakeholders add their expertise to comp advisory board
By Nancy Grover
A licensed claims adjuster in New York with more than 20 years of experience, Eichler is the director of government and insurance services for the Guidelines Division of the Reed Group. He is involved with treatment guidelines, both nationally and state-specific, working with regulators and workers' comp stakeholders. Additionally, he is the vice chair of the International Association of Industrial Accident Boards and Commissions' Disability Management and Return to Work Committee and a member of the Advisory Council.
Eichler believes increased communication between regulators and stakeholders is sorely needed to develop effective solutions to the challenges in the workers' comp system. Among them is the need for enhanced cost containment without compromising the quality of care of claims handling.
"There is definitely a need to decrease transactional processes, locally, regionally, and nationwide," he said. "With increased regulation has come increased processes and increased costs, as well as delays in responding to claims."
States' efforts to reform their workers' comp systems, whether through legislation or regulation, has resulted in bureaucratic layers being added without streamlining, he said. The increased red tape has drawn comments from workers' comp insurers.
"Carriers are saying it is more difficult to maintain profitability in the workers' comp arena with the rising costs and increasing transactional processes," he said. "I'm hearing many carriers are looking on a market specific basis and considering pulling out, which will leave fewer options for insureds and result in increased market share for state insurance funds."
Adding to the challenges and costs are excessive litigation and a lackadaisical approach to returning injured employees to the workplace. He believes the answer to many of the current obstacles in the workers' comp system lies in better sharing among stakeholders and studying various systems "not only domestically, but abroad," he said, " learning from what works and, more importantly, from what doesn't work."
Eichler says the workers' comp stakeholders in the U.S. would do well to look at systems in other countries.
"If you look at the WorkSafe programs in British Columbia and some Canadian provinces, they've had great positive results and improved outcomes," Eichler said. "They've been able to achieve, over a number of years, cultural paradigm shifts to the point where you have miners' unions endorsing return to work and injured workers requesting RTW."
In his recent work with workers' comp participants in China, Eichler says he has been particularly impressed with the attitudes there. "Injured workers are embarrassed if they have been injured at work and almost feel responsible and are upset they are not necessarily functioning and contributing to society and the workplace and putting an unnecessary burden on their coworkers and their families."
Maureen McCarthy. McCarthy is the senior vice president for commercial market claims and managed care at Liberty Mutual Insurance, where she oversees a staff of 2,000.
In her three decades with Liberty Mutual, she has gained extensive experience in claims, managed care, utilization review, medical bill review, and field/nurse management. She has also worked in personnel management, training, and development.
As the manager of field operations for one of the nation's largest workers' comp carriers, McCarthy sees a need to support claims professionals' inherent skills with technology in order to deliver value to policyholders, the brokers, and agents who serve them and injured workers.
"Everyone in the workers' compensation process benefits by producing the best medical outcomes possible for injured workers and quickly returning them to the workforce," notes McCarthy. "Achieving these shared goals requires that we constantly seek to provide our claims professionals with the best technology and also that we continually provide training and development opportunities to enhance critical thinking and communication skills."
The value of blending technology and skill is most clearly seen in managing the small number of workers' comp claims with risk factors that can significantly drive total claim costs.
"It takes sophisticated analytics and reporting for an insurer to identify claims that have one or more of the factors known to potentially inflate costs and extend durations," said McCarthy. "And technology plays a key role in notifying adjusters of these claims and suggesting strategies to manage them. But it is the skills of individual claims professionals that largely drive successful management of these claims."
For example, she says it takes critical thinking, sound judgment, and top-notch communication skills for a claims professional to partner with an employer, an agent or broker, the claimant, and -- in appropriate states -- medical providers to develop an action plan to successfully manage a claim.
One way to enhance these skills is to incentivize claims professionals. According to McCarthy, her group recently revamped its quality assurance program and reduced the focus on process while rewarding critical thinking and solid decision-making by claims professionals.
"Five years ago, we expected adjusters to call providers within two days and contact employers within one day -- that was how we measured their success," McCarthy said. "Now, the emphasis is on what happened when claim professionals make calls. What did they talk about? If it took two days instead of one but the claim professional received the information needed to deliver a better medical outcome, then the adjuster is recognized for meeting our true goal."
According to McCarthy, a lot of employers, brokers, and agents have noted a big drive toward critical thinking, especially as they try to manage the small percentage of cases that tend to drive the big dollars. "That's why it is so important to focus on both arming claims professionals with technology and improved skills," said McCarthy. "That's the only way for a claims operation to truly deliver value."
Read more at the WorkersComp Forum homepage.
January 30, 2012
Copyright 2012© LRP Publications