While we all hope to live a long, healthy life, it’s unlikely that we can avoid some level of illness or disability. With 129 million Americans currently dealing with at least one chronic health condition, the chances of being faced with a condition leading to time away from work are increasingly likely.
When it comes to drivers of disability, there is growing recognition of the correlation between chronic illness and mental health impacts. In fact, for those with a chronic condition who completed a mental health assessment, the Mental Health Association found high rates of positive or at-risk responses.
Given the growing complexity of chronic illnesses and mental health impacts, there can be additional challenges to navigating these disability claims. From providing the proper training and skill sets to leveraging a holistic approach to assessing the claim, disability carriers must be prepared for evolving complexities in disability claims.
Key Factors for Effective Complex Claims Management
Prioritize Skill Development
Communication with claimants is vital to navigating complex claims. According to an RGA survey of global claim professionals, 26% of claims managers see communication as the highest priority focus for professional development, especially for claims with a mental health component.
In the evolving landscape of disability operations, telephone communication is still preferable over electronic communication. This method allows the claim analyst to better assess the claimant’s physical and mental health condition, including their symptoms, treatment plan, and discussions with their providers. Ensuring a claim analyst can effectively conduct an interview can lead to a complete view of the medical situation, the claimant’s perceived functionality and potential obstacles to recovery.
In addition to communication, soft skills such as empathy are necessary for effective claim management. Leveraging empathy during conversations with claimants builds trust and enhances the quality of these interactions. Training focusing on specific language, listening skills and honing emotional intelligence can position claim analysts to better navigate conversations.
Optimize Resources
Experience is vital to effectively managing complex disability claims. Identifying the best fit with the necessary experience can help put them on the right track at the start.
Segmenting the claim block for optimal analyst proficiency is also helpful in ensuring the best resources for the claim. Leveraging knowledge in handling these types of claims is an essential strategy that can put the right resources to work where they can make the most impact.
Additional specialized tools and resources can help navigate a complex disability claim. Utilizing behavioral health specialists to identify psychosocial issues impacting a claim can offer insights into how to assist with a claimant’s recovery.
Incorporating technology such as interactive applications can also mean gathering real-time information that in turn sheds more light on a claimant’s return-to-work motivation. Other tools now exist that leverage a scoring methodology or automated claim trigger process to support carriers in identifying opportunities for analysts to follow up at a critical interval in a claim.
Develop a Holistic View
When analyzing a disability claim, it’s essential to integrate subjective complaints and consider all reported conditions, especially complex ones. Utilizing a “whole person” or holistic view can uncover issues earlier in the life of a claim such as perceptions of functional loss or limitations, restrictions on returning to work and more.
In addition, taking a holistic approach to case management is also valuable. Identifying the spectrum of stakeholders and specialists who should be involved is important to the outcome.
For example, clinical partners play an instrumental role in managing complex claims. They help with reviewing medical information once obtained and offer guidance on requesting medical information. Claimants often consult or are referred to multiple specialists, so collaborating with clinical partners can help a claims analyst determine which medical records to obtain and when.
At Brown & Brown Absence Services Group, we are proud to offer a robust network of medical specialists and seasoned claim professionals equipped to assess the most complex of claims. Contact us to discuss how we can help your claim organization.
