5 Key Components to Successful Claims Management During a Crisis
A crisis can refer to many kinds of events, from a mass shooting to a wildfire, hurricane or even a viral pandemic. By definition, a crisis is any unexpected set of circumstances that require immediate action and flexibility to manage them.
Successfully managing claims during a crisis requires a claims team who can move quickly to implement solutions that meet the needs of the environment.
“COVID-19 is likely the largest crisis we’ve ever collectively faced,” said Jeffrey Sickles, senior vice president, claims, Crawford TPA: Broadspire. “It reiterates the need to have a claims management strategy and a business continuity plan pre-crisis. Events unfold very quickly.”
In times like these, with more questions than answers surrounding COVID-19, safety is the number one priority for many employers and employees alike. To keep business moving forward, organizations across the country have shuttered their doors, opting for work-from-home as most Americans have been ordered to shelter in place.
In this fast-paced environment, meeting the needs of clients requires a fast-moving response.
“As members of a claims management team, we’re partially responsible for people’s livelihood,” said Cynthia Curd, national vice president of claims operations, quality and compliance, Crawford TPA: Broadspire. “Not just those exposed to COVID-19 but also the individuals who already had existing claims. We have to be prepared to handle whatever is happening to continue meeting their needs,” which starts with a strong strategy.
“The claims management strategy, as well as the business continuity plan, has to have a good foundation,” explained Erica Fichter, senior vice president, medical management, Crawford TPA: Broadspire.
Having a solid foundation going into any crisis enables the claims management team to pivot quickly, regardless of what the crisis is. Here are five key components to a successful claims management strategy during any crisis.
1) Communicate real-time solutions and actions with employees and clients to keep everyone involved.
For claims management, clear and consistent communication between the claims team and the injured workers receiving care is always a must. What sets COVID-19 apart from other crises, however, is its impact on both clients and the claims management team providing service.
For Broadspire, with claims adjusters working out of brick and mortar Service Centers, plus field adjusters and nurse case managers in the field, shelter-in-place meant a complete overhaul of how claims were handled.
“So much of our business is face-to-face,” explained Sickles. Nurse case managers, for example, were used to visiting with workers, attending doctor visits and the like. With shelter-in-place, however, such activities had to be reconfigured overnight.
“It’s why communication is absolutely critical,” said Fichter. “When face-to-face is no longer an option, we still need to communicate.”
Internal communication, as well as external communication, become a large part of managing claims through a crisis. As part of the crisis claims management strategy, teams must have a plan in place to communicate effectively with all parties involved in the claim.
Teleconferencing, email updates or even a special employee/client newsletter are some easy options to keep the lines open. Having a regular cadence of meetings on the calendar can also improve and open up the lines of communication.
Another thing to keep in mind in addition to constant communication is reviewing all information for accuracy.
“If we don’t maintain communication with employees or clients, they are not going to be grounded as they could be,” said Curd.
She explained that, in a worst-case scenario, clients and employees could easily create their own answers that may not be fully reflective of what the claims team is doing or how it is addressing the crisis at hand.
“It’s very important that clients and our employees hear these things directly from our mouths, so they know what we’re doing,” she said.
2) Keep an eye on regulatory and jurisdictional responses to any crisis.
A hurricane, tornado or another natural disaster can bring bodily injury as well as property damage to a localized area. In times of crises of this nature, a good claims management team should be prepared to advocate on behalf of injured workers in that area, and as part of that duty, the team should watch how local jurisdictions respond.
With COVID-19, however, the need to have a pulse on regulatory change has increased tenfold.
“The biggest difference here is that this crisis is impacting the economy,” said Sickles. “When it comes to insurance and claims, COVID-19 has a direct effect on workers’ compensation claims as well as leave and benefits management.”
Wage replacement benefits and medical treatment are two of the top concerns in workers’ comp claims management. With many businesses shuttering their doors, however, and hospitals turning their attention toward disease control, both these elements are being impacted tremendously.
“The scope of this crisis,” said Curd, “and the magnitude it has already reached make COVID-19 so very different from other situations these jurisdictions have been in before.”
Jurisdictions across the U.S. are reacting to the crisis in the best interest of the counties they protect. It’s important, then, for the claims management team to watch and understand what the jurisdictions where injured workers reside are doing and how those decisions can impact open claims.
One way to stay abreast of any changes being put into place, added Sickles, is to work closely with the defense attorneys, boards and court systems in each jurisdiction your team operates in.
3) Modify products to meet the needs of the current situation.
When a crisis presents, business-as-usual isn’t always the way to go. Claims management teams need to be adaptable to the situation at hand in order to continue to meet the needs of clients. That starts with product offerings.
Telephonic case management, telerehab visits and constant communication are just some of the ways a claims management team can stay ahead of a crisis and maintain care.
“With COVID-19,” Fichter said, “we’ve had to figure out how to implement products that meet the requirements of social distancing.”
This started with how the team conversed with clients, now moving communication lines to a digital platform.
“We operate face-to-face. We talk with doctors about treatment and return-to-work strategies. But that wasn’t an option. So, we’ve included more telephonic follow-ups with treating physicians,” she said.
Telephonic care enables the claims management team to document real-time updates on a claim. It also keeps the claim moving forward, with discussions on an individual’s care plan to keep them on target.
“Even with certain types of provider visits being postponed or canceled, utilizing this telephonic system enables the claims management team to work together,” Fichter added.
4) Pivot when necessary to meet the needs of the market.
Quickly developing or expanding products to meet the needs of the market is a consistent challenge in a crisis. The products or services needed can easily change day by day.
The question, then, is how does the claims management team learn to adapt quickly and expand product offerings to meet the needs of the market?
“One thing to come out of COVID-19, as an example,” said Fichter, “is employees asking if we have a program for someone who is coming out of quarantine. Do we have clinical coaching available or guidelines written on how they can come back?
“That’s something that’s come out of this particular crisis, and it’s something we know we have to think about.”
Listening to what’s going on is a fundamental part of adapting, she added, and it is to the benefit of the claims team, employees and clients to be reactive to their challenges.
Additionally, providing clients with real-time data on the crisis at hand can go a long way.
Broadspire, for example, has been working since the start of the pandemic to incorporate daily visual reports to show clients precise data points that provide insight into how COVID-19 is impacting the clients’ programs.
Ongoing reports and dashboards enable clients to track claims and see the locations where COVID-19 is having an impact.
“We’re combining client data with publicly available COVID-19 data to devise solutions for our clients, based on infection rates and claims by location,” explained Sickles. “It’s another way we’re working to shift our focus to needs of the market.”
5) Support clients and employees with intention, empathy and compassion.
For workers’ compensation professionals, support, empathy and compassion are a given in claims management. During a crisis, these elements are even more so important to having a successful claims management strategy in place. Injured workers, who may already be experiencing difficulties, could find their lives altered even further. Businesses large and small can be impacted by dramatic increases in claims or business closures, which require special attention to recover.
“People are scared during a crisis,” said Curd. “There are many unknowns, and it takes a supportive, empathetic team to help guide clients through the process.”
According to Sickles, advocating for employees and clients is key to successful claims management during a crisis.
“Medical management is at the core of what we do. This is a time where nerves are high, because medical treatment might not even be available to an injured worker. Or their employer might not be in business.
“At the end of the day, COVID-19 changes what’s happening with a workers’ compensation claim. It’s completely out of the worker’s control,” he continued. “You almost have to take claims advocacy to a new level while managing the claim.”
Being readily available to answer questions, discuss treatment and care, and listen to the injured worker during a crisis can positively impact their recovery and the claim.
What a Claims Team with a Strong Plan Should Look Like
Current events have proven just how imperative it is to have a claims management team with a plan in place. While crises like a natural catastrophe, which impact a finite area and group of people, are destructive and costly in their own right, the COVID-19 global pandemic has shown just how important a crisis management plan can be.
At Broadspire, now more than ever, crisis management is of top priority.
COVID-19 has generated uncertainty and questions across the globe, but its claims management team is supported by the strong crisis management and business continuity plans they’ve already put in place.
“We have a great pool of technical resources, we have a ton of field and telephonic case management nurses and a large staff of experienced claims professionals, all of whom are prepared to work with clients during a crisis,” said Sickles.
“As with any individual claim or wide-reaching situation, we are maintaining our focus on supporting our clients while also keeping our employees safe.”
To learn more, visit: https://www.crawco.com/covid-19/broadspire-crisis-support-solution.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Broadspire. The editorial staff of Risk & Insurance had no role in its preparation.