PERSONAL INJURY GETS PERSONAL: WORKERS’ COMPENSATION IN 2017
Mark Daniels - National Business Development Manager, Strategic Sales
AGENDA
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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
EVOLVING SOCIAL AND CULTURAL FACTORS
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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
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• 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
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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
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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
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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
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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
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THE IMPACT
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• 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
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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
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• 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
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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
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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
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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
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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
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COMPLEX CLAIMS SERVICE MODEL
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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 AGENT’S ROLE
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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
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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