Workers’ Comp Executives and Claims Professionals Agree: Here Are 3 Positive Developments in the Industry

The Rising 2019 Workers’ Compensation Benchmarking Survey explored the experiences of frontline claims professionals for the first time.
By: | January 20, 2020

Few people know more about the state of workers’ compensation today than boots-on-the-ground claims professionals. Everyday, they’re interacting with injured workers to make sure they get the best treatment possible and to ensure the claim runs smoothly. 

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Their frontline knowledge of the industry is one of the reasons their perspective is becoming valued by those looking to study the state of the industry. 

“We’ve got a ‘perfect storm’ threatening the workers’ compensation industry right now,” Rachel Fikes, chief experience officer and study program director at Rising Medical Solutions, said in a press release. 

“Frontline claims professionals are the largest and most influential employee population in our industry, yet very little research has been conducted with them to date. Adding frontline intelligence to the study’s cumulative data can help organizations advance claims management and talent practices, as well as confront the increasing stakes of attracting young professionals to our industry.”

To do just that, the seventh annual Rising Workers’ Compensation Benchmarking Survey pivoted from surveying executives about the state of the industry to investigate the day-to-day experiences of claims professionals. 

The 2019 report surveyed 1,282 claims professionals in order to compare how their views either reflect or differ from those of the over 1,800 industry leaders who have participated in prior research by Rising. 

The report found that industry executives’ and frontline professionals’ views largely aligned when it came to day-to-day priorities, overarching goals for care and the challenges that are facing workers’ comp as a whole. Here’s what the study shows:

1) Executives and Claims Professionals Have the Same Priorities

The 2019 study found that workers’ comp executives and claims professionals agreed on the top three core competencies most critical to claims outcomes when compared to the 2017 report. 

The competencies they agreed were most important are: medical management, disability/return-to-work management and compensability investigations. 

While executives and claims professionals agreed on the three core competencies, they ranked them slightly differently; in the 2017 report, executives ranked medical management as their number one priority followed by disability/return-to-work management and compensability investigations. 

Claims professionals, on the other hand, ranked compensability investigations as their top priority, followed by disability/return-to-work management and medical management. 

These core competencies also reflect the areas where claims professionals are spending most of their time. 

According to survey results from the 2019 report, claims professionals spend most of their time working on medical management, followed by compensability investigations and disability/return-to-work management.

2) Putting Injured Workers First

In addition to sharing the same priorities for day-to-day claims management, claims professionals and executives also agreed that an injured worker’s well-being should define what makes a good claim outcome. 

In the 2019 report, claims professionals ranked return-to-work achieved by anticipated outcome/benchmark as the number one way they measure a good claims outcome. 

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This was followed by measurements such as the employees functional abilities and medical improvements achieved by the expected outcome. 

Measurements focused on claims closure or avoiding legal conflict were ranked as the least important measures of a successful claim by claims professionals.

Comparatively, in the 2017 report, industry leaders ranked an employee’s return to functional abilities as the number one measurement of a good claim and return-to-work achieved by anticipated benchmark as number two. Like claims professionals, they ranked lack of litigation as the least important measure.  

These results are reflective of the industry’s shift toward injured worker advocacy rather than an antagonistic perspective as a whole. The results of this report solidifies that this approach has been embraced at all levels of the industry.       

3) Need to Address the Talent Crisis

Similar to the worker crisis faced in insurance, the workers’ compensation industry is also facing a talent gap. The Rising report even called the talent shortage “the most significant [one that] claims organizations face.”

As a whole, the insurance industry will need to fill 400,000 positions in 2020, the report notes, and unemployment nationwide remains low, with an average of 3.6% nationally for 2019 and 1.5% for property/casualty. 

All these factors combined will make 2020 a competitive candidate market for workers’ compensation employers looking to fill open positions. 

For companies trying to stay competitive, the survey’s focus on the experiences of frontline claims professionals could help them identify areas where they can support employees and improve retention.   

The report found increased support and training could help workers’ comp employers attract and retain young professionals. According to the survey, only 25% of frontline staff received training on empathy, a skill that can help when working with injured workers. 

Young workers’ comp professionals are especially interested in additional training, especially jurisdictional training. 

Forty percent of survey respondents overall indicated a need for jurisdiction-specific training. Among professionals with between one and five years in the industry, this number jumped to 53% and 45% for professionals with less than a year of experience.    

Room to Improve

The Rising survey found claims professionals and workers’ comp executives shared many of the same priorities, but there is still room for the industry to improve. 

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The use of data and analytics stood out as a blind spot for the industry. The report found that over a third of claims professionals reported they do not use data or analytics to manage claims. 

This number is staggering, and it’s not the end of the industry’s tech woes. Fifty-four percent of claims professionals reported their claims system needed upgrades or advancements, and 34% said they needed better tools for communicating with injured workers. 

Technology usage isn’t the only area where the industry could use some improvement, according to respondents. Claims professionals also reported a desire for more medical management training, especially in the areas concerning mental health. 

Only 31% of claims professionals reported that they strongly agreed that they had received adequate medical management when it came to areas of mental health, and 16% of workers reported that they believed they did not receive adequate training in this area. &

Courtney DuChene is a staff writer at Risk & Insurance. She can be reached at [email protected]

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The R&I Editorial Team can be reached at [email protected]