Your Workers Compensation Program Has a Claim Problem

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Last week, we spoke about the lack of transparency and compliance with Medicare Secondary Payer (MSP) in the Property & Casualty claims environment, and the reasons for that.  

Did you also know that despite all the “pats on the back” for underwriting profitability with a calendar year combined ratio of 87, that Workers Compensation has a serious claim problem?  

You would not know it from the NCCI (National Council on Compensation Insurance) Annual Issues Symposium State of the Line Key Insights:  

  • The workers compensation line is strong and healthy. 
  • The system saw its eighth consecutive year of underwriting profitability with a calendar year combined ratio of 87, outperforming other property-casualty lines. 
  • Net written premiums rose about 1% in 2021. 
  • Lost-time claim frequency data suggests the long-term decline continues, despite a rise in frequency in 2021. Since 2019, frequency has declined slightly. 
  • There is no change expected in medical and indemnity claims severity in 2021. 
  • There are potential challenges ahead as medical costs could experience inflationary pressure. 
  • Workers compensation reserves are robust. Reserves grew to $16 billion redundant as of year-end 2021. 

Despite these positive bullet points, the claim environment itself is not “healthy,” it is coughing and choking with staffing shortages, social inflation, poor clinical outcomes, gross inefficiencies and increasing costs. Your risk managers are feeling the effects and seeking alternatives to the chaos, without increased premium payments. Who wants to pay more for less?  

The insurance market has historically focused on underwriting results as its measure of success, yet the claims department is the heartbeat of Workers Compensation. The claims environment is where people who are injured receive care, where there is an opportunity to show the moral and financial value of Workers Compensation, the way it was originally intended.  

InsurTech is a movement to “humanize” and improve the customer experience, with scalable technology. To align the financial goals and incentives with improved outcomes and customer satisfaction, to view the Injured worker as a stakeholder.  

To a commercial claims carrier, the customer is the company that is paying premium, so there is no direct connection between the insurance company and the injured worker. This lack of connection is the catalyst driving consumer demand for better insurance products that can be accessed in real time; getting exactly what you need, as quickly as possible. By that measure, legacy claim organizations are underperforming. There is an immediate and escalating need for claim organizations to use technology to fill human resource gaps and meet consumer demands.  

At Care Bridge International, we streamline and automate claim medical reserves, Medicare Secondary Payer compliance and Care Management with our Claim Management Action Plan (ClaimMAP), included with every claim processed.  This approach establishes a baseline for medical expenditures, an appropriate care pathway and the management of Medicare Secondary Payer compliance in a risk enterprise platform.  

Our tech-enabled solution not only improves claim outcomes and reduces costs 40% – 70% or more, it also provides dashboard capabilities for managers to measure and monitor claims. Data driven insights that support a collaborative and focused approach to claim and risk management that can easily integrate with your claim system.  

For claim environments struggling with inefficient or absent claim systems, Care Bridge International has the capability of structuring your un-structured medical records to provide you with the same data analytics capabilities as a more advanced company.  

Get your claim department back to health with Care Bridge International.  

For more information:  

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