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Claims Management

How to Sabotage Your Complex Claims Handling in One Easy Step

a:1:{s:11:"td_subtitle";s:219:"Silence is not golden when it comes to navigating the complex medical management claims process. We illustrate various ways that limited or complete lack of proactive communication can negatively affect claims outcomes.

May 5, 2023

The ability to care for severely injured workers has never been more exciting. Medical advances are improving the efficiency of claims management and the effectiveness of patient treatments, offering the ability to restore catastrophically injured workers in situations that would otherwise result in permanent disability or death. However, medical advances and technology will not help improve claims outcomes on their own. There is one element that is necessary to successfully steer a claim to the best possible outcomes – communication. Lack of communication between all claims stakeholders, including the injured worker, claims adjuster, nurse case manager, insurance carrier, and legal, can have dire effects.

“Regular communication with a focused plan of action sets key claims team members up for success,” said Stacy Whalen, Senior Medical Manager at Safety National. “The approach to each complex claim should begin by establishing an initial call between all claims management stakeholders, followed by a regular cadence of communications that include updates with actionable takeaways.”

Lack of regular communication can negatively impact claims outcomes in the following ways:

  1. Prevents medical progress by not determining correct treatments, or delaying them from being assigned to the patient.
  2. Leads to claim stagnation, which not only impacts the ability to help the injured worker, but also can unnecessarily drive up costs.
  3. Limits the claims management team’s ability to address barriers or other issues as they arise. This could potentially lead to lengthy and expensive developmental claims.
  4. Creates an environment of unclear expectations for everyone involved, including the injured worker, claims team, and nurse case manager.
  5. Increases the potential for the injured workers to stray from the treatment plan or lose interest altogether.
  6. Creates an atmosphere for medical care to drag on and impedes the ability to mitigate in an effective manner.
  7. Results in team confusion as to who is doing what, how to identify the next steps, and who has what authority to address those actionable items.

When it comes to complex claims, it is important to determine a communication plan as soon as possible to avoid the silos that impact the claim’s progress. More importantly, it provides the foundation to efficiently and effectively get the injured worker on the right treatment plan to help restore their quality of life.