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Returning injured workers to health can help drive down claims costs

Leaving legacy claims closure rates unchecked can drive up the Total Cost of Risk (TCOR) a major contributor to their bottom lines.

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06/16/2023 · 5 minute read

Worker shortages continue at companies across industries, with an imbalance in labor demand versus supply in what has been described as the tightest job market since World War II. Retailers, restaurants, and food and beverage companies are struggling to fill vacant positions, while getting injured workers back to work continues to be a major challenge.

Why is pending claims volume up?

A record number of employees — close to 48 million — quit their jobs in 2021. At the same time, data collected by Marsh shows that the turnover rate at claims administrators has gone up by more than 50% in the past year. 

And even when third party administrators (TPAs) are able to hire new people, in many cases there has been a significant loss of experience, increasing the time needed to review cases. While adjusters have the tools and training to calculate benefits, many lack the experience to effectively negotiate settlements with injured workers, increasing the case backlog and often delaying the injured workers’ return-to-work.

But the pandemic-era “great resignation” is only one issue affecting injured employees’ return to work. The early months of the pandemic saw many elective medical procedures postponed either by healthcare organizations that needed to focus on COVID-19 patients or by injured workers who wanted to reduce their exposure to the virus. This led to injured workers returning to health at a slower pace than they would have if they had received necessary care — such as surgery or physical care — in a more timely manner. These delays amplified workforce shortages.    

Further, the shutdown of courts as COVID-19 cases peaked led to a backlog of workers’ compensation cases, prolonging the timeline to resolve cases and get injured employees back to the workplace.

3 actions to help injured employees return to work

The timely resolution of workers’ compensation cases that allow for the return of employees — either to full or modified duties — is critical at a time when retailers, restaurants, and food and beverage companies are dealing with significant worker shortages. Consider the following three actions to reduce workplace injuries and help injured employees get back to health and able to return to their duties:

  1. Identify problematic claims. One major stumbling block to resolving cases is lack of visibility into claims data. A significant number of open cases, coupled with fewer claims administrators, often leads to missed opportunities to identify potentially problematic claims that are likely to drive up costs. Online dashboards can present a clear picture of your high exposure cases, allowing you to pinpoint claims that should be addressed on a priority basis, such as cases awaiting employer accommodation for light duty or those postured for settlement that have not yet been evaluated. Claim complexity scoring can help you identify which claims you should be focused on, before they become a problem. 
  2. Take an advocacy based approach with injured workers. Workers who feel they are not experiencing proper responsiveness and empathy from their claims administrator are generally more likely to seek legal representation, which often drives up costs and the length of time to settle a claim. Additionally, when an injured worker seeks attorney representation, there is a lower likelihood of them returning to work for your organization. A heavier workload for claim examiners makes it more difficult to identify cases that require an immediate follow-up. For example, if there is a delay in contacting an injured worker to inquire about a missed healthcare visit — and offer assistance to reschedule the appointment — the time for injured workers to reach full health and return to work may be lengthened. 
  3. Detect and address causes of injury. Well-organized data can help you identify potential system deficiencies or an inadequate safety culture that could lead to injuries, such as insufficient training of new hires or a management philosophy that prioritizes sales over the safety of your workforce. Dashboards can alert your TPA or internal claims team to similar incidents — even at different premises — allowing them to investigate the potential root cause of the problem and address it to keep workers healthy.

As new variants of the COVID-19 virus emerge, there is concern of a significant wave of infection in the fall and winter, with a forecast of 100 million potential coronavirus infections in the cold-weather months. Considering that this is typically among the busiest periods for retailers, restaurants, food and beverage companies, senior leaders should take the necessary action to address pending workers’ compensation cases and return employees to the workplace.

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