Improving Outcomes Through a Streamlined Claims Management Process

Improving Outcomes Through a Streamlined Claims Management Process

Integrating workers’ compensation, disability and leave management can result in improved outcomes for employers and employees.
Contributors
Allison Scaia
Allison Scaia, Head of Health Services at The Hartford
Matt Scott
Matt Scott, Head of the Northeast Division for Middle and Large Commercial, The Hartford
A common pain point for businesses revolves around the leave and claims management processes surrounding employee absence. An inefficient claims process isn’t just frustrating to deal with, but can also negatively impact productivity and affect how quickly an employee returns to work following an injury or illness.
 
It can also be difficult to navigate the complex laws and regulations around absence management. In fact, in The Hartford’s 2020 Estudio sobre el futuro de los beneficios, 55% of employers said there’s not an easy way to track and manage the different types of leave.
 
For injured or sick employees, these processes can be frustrating. Poor communication, confusion and the lack of transparency can cause a bad experience. 
 
The claims process for workers’ compensation insurance and disability, combined with the complexities of absence management, can be time-consuming. These issues present an opportunity for employers to make changes to have a more streamlined claims management process.
 
“A traditional claims management process can place a high amount of administrative burden on employers and really cause frustration and a poor experience for the employer and the employee,” Scaia noted. “There’s value in having an integrated claims process not just because it makes things easier, but that it can also provide valuable insights to help employers and their workers.”
 

What Is a Claims Management System?

A claims management system handles claims from when they’re initially filed to when a decision is reached. This process involves information gathering to allow an insurance company to decide on how to address the claim. 
 
Most employers have certain large business insurance coverage and other products to help protect their employees or because it may be required, like workers’ compensation insurance (WC insurance), leave management and disability.
 
Traditionally, a claim can go through different systems. For example, an employer would file a workers’ compensation claim with their insurer to make sure an employee injured at work gets the benefits they’re entitled to receive. And if the injury or illness was unrelated to work, the employee would have to file a separate claim for disability benefits.
 
For example, say an employee complains of leg pain as they’re working on the manufacturing floor of a food packaging company, there are certain steps that must be followed:
 
  • The business is required to file a workers’ compensation insurance claim with their insurer.
  • If it’s determined that the injury is not job-related, then a disability claim would need to be filed.
  • If the employee can’t work and has to take a leave, the employer would need to document and record this in their absence management system.
For both the employer and employee, this entire process can be time consuming and potentially confusing, with so many different moving parts.
 
If an employer isn’t reporting or documenting leaves or employee injuries accurately, they can face costly lawsuits and fines. In fact, the average cost to defend a Family Medical Leave Act (FMLA) lawsuit is $78,000 – regardless of the outcome.1
 

How Can Claims Management Be Improved?

There are different measures that employers can take to try and improve their claims management process, such as keeping accurate information and documentation.
 
If there’s a work-related injury or illness, it’s a good idea to note important information that can help with the workers’ compensation claims process, such as:
 
  • Date of injury or illness
  • Where it occurred
  • Description of what happened
  • Date of when employer received notice of injury or illness
Some insurance companies are also trying to help employers with improving the claims management process – especially if they have certain products and services with the same insurer.
 
The Hartford leverages data to improve claim outcomes. Its Insights FactoryTM uses data to provide insights into the biological, psychological and social factors that can impact a claim. Over the course of five years, short-term disability durations were 5% shorter and employees returned to work 3.4 days faster.2
 
The Hartford also designed a program that integrates workers compensation and Group Benefits products. Called “The Hartford Productivity AdvantageSM (THPA),” it streamlines the claims and absence management process for employers and employees. Scaia explained that the insurer designed THPA to:
 
  • Reduce administrative burden and compliance risk for employers
  • Improve the employer and employee experience by removing barriers and additional steps
  • Provide absence insights to enhance productivity
When you consider that 71% of the time a workers’ compensation claim with three or more days of approved absence doesn’t have FMLA set up, a streamlined approach can greatly benefit employers.3
 
“With THPA, a single workers’ compensation claim gets submitted and triggers the appropriate leave and disability action. Employers and employees don’t have to call in a second time to set up a leave, which streamlines the process and improves the experience for everyone,” Scaia explained.
 

A Look at the THPA Claims Process

Here’s how the claims and leaves process works with THPA:
 
  1. An employer files a workers’ compensation claim with lost time from work.
  2. FMLA is initiated (subject to an employer’s eligibility) in coordination with the workers’ compensation claim to track time away from work.
  3. If the workers’ comp claim is approved and lost wages are paid, the information is used to approve the leave.
  4. If the workers’ comp claim is denied, The Hartford initiates a short-term disability claim (subject to an employee’s eligibility) and uses any workers’ compensation medical on file after getting authorization from the employee.
The offering also allows employers to analyze data for leave, disability and lost-time workers’ compensation claims. A dashboard gives them the opportunity to improve productivity planning and ultimately, reduce administrative burden.
 

A THPA Success Story

A national food packaging company faced lawsuits and fines because it wasn’t documenting any work-related employee leaves. 
 
As a workers’ compensation, disability and absence customer with The Hartford, the employer was able to benefit from THPA’s streamlined process. 
 
With THPA, a leave gets created when the employer submits a workers’ compensation claim. The automatic creation of corresponding leaves improved the employer’s compliance and tracking.
 
The food packaging company praised the “seamless coordination” and credited THPA for “saving time and energy while improving the communication with our employees.”
 

Integrated Services To Improve Claim Outcomes and Processes

Improving a claims management process benefits both the employer and employee, according to Matt Scott, head of the Northeast Division for The Hartford’s Middle and Large Commercial business.
 
“Employers don’t just see increased productivity with an integrated approach to claims and leave management, but also lower administration costs and reduced compliance risk,” Scott said. “Employees also have higher satisfaction and a better experience because there’s a seamless coordination of benefits and streamlined process.”
 
 
1 HR.com: Presagia, “How Well Do You Understand the Intricacies of FMLA Compliance?”
 
2 As compared to IBI industry data. 
 
3 Based on The Hartford’s review of Workers’ Compensation lost time claims and corresponding FMLA compliance from 2018-2020.
 
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