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