In Part 1 of this series, we introduced the behavioral construct of Self-Determination Theory (SDT), which states that people have three innate psychological needs: autonomy, competence, and relationship needs. Impeding or not supporting any of these needs will negatively affect well-being.
In the second part, we introduced cognitive load and executive function, the first being the amount of working memory that is occupied at any given time and the second being the mental skills needed to perform a task. We have proposed that the complaints process could be significantly improved by adopting the information provided by these characteristics of human behavior and psychological functioning.
SDT provides the overall framework to guide the design of systems and interactions in the process to promote positive outcomes for claims. Simplifying systems (for example, through the activation and automation of technology) is an effective way to reduce demands on cognition and executive function.
This third part of the series explores behavioral and psychological elements related to the psychosocial aspects of workers’ compensation claims.
A better way forward
Over the past decade, the workers’ compensation industry has begun to appreciate the impact of psychosocial issues on claims outcomes. Things such as an individual’s attitude, state of mind, worldview, recovery expectations, and willingness to return to work can affect results.
In addition, the social environment, living conditions, transportation capacity, financial well-being, interpersonal relationships, and family and household responsibilities of an injured worker can also affect the recovery trajectory.
Current complaints management processes and systems rarely capture this psychosocial information that could provide a more complete view of the context in which a person is trying to recover. Using automated messaging capabilities (i.e. Momentary Ecological Assessment or EMA), real-time psychosocial information can be collected from injured workers, providing early warning for issues that may affect their recovery and prompting a claims professional to take action.
Simple questions about an injured worker’s optimism, positive attitude, and satisfaction with suppliers or claims professionals can indicate the trajectory of a loss. The information derived from the EMA can help adjusters navigate psychosocial issues by providing information to help start a conversation with the injured worker about things that affect recovery that are otherwise unknown or difficult. to speak.
âThe Workers Compensation Benchmarking Study highlighted that psychosocial issues are a key driver of claims costs. It is important for us to think about how we can best uncover and resolve these issues, so that we can do what is best for the injured workers we serve and ultimately deliver the best results for them. complaints. – Daniel Brewer, AVP & WC Manager, Sinistres, The Cincinnati Insurance Companies
The real-time assessment of the injured worker and his situation as well as telephone follow-up are inspired by the theory of planned behavior, motivational interviewing and social and cognitive theory. It seeks to identify attitudes, beliefs and motivations, as well as to identify social and environmental factors that can affect an individual’s recovery.
A follow-up phone contact then allows the claims team to provide additional emotional support and encouragement to the injured worker.
These digital and phone contacts assure the injured worker that they are not alone, that they are not being forgotten, and that there are resources to help them every step of the way to full functioning.
Frequent checks not only help identify issues and stimulate follow-up, but also provide substance to deepen the interpersonal bond between the injured worker and their grievance team, which is essential in building trust.
Lack of trust is a common occurrence in the claims process and is often a trigger for an injured worker seeking legal involvement, increasing the overall claims costs. Injured workers who feel like they are not being heard or who feel isolated and disconnected are more likely to seek a lawyer who will give them the support they need.
âThere is no good reason why protest organizations cannot use worker advocacy strategies in the interest of a better injured worker experience and improved combined ratio that accompanies it. – William (Bill) Zachry, Board Member, California State Compensation Insurance Fund, Former Vice President, Safeway / Albertsons Risk Management Group, Former Principal Investigator, Sedgwick Institute
We hope this three-part series inspires you to innovate within your own complaints organization. It is not Sisyphus’s task to design an injured worker experience that reduces the stress and anxiety of the process. Your efforts can allow injured workers to devote all of their energy to recovery.
And you can bring the concept of âclaims representationâ to life by giving the right advice to your claims professionals, helping them focus on building a human relationship and trust with their injured workers. These are key elements in speeding up collection and reducing the need for litigation, saving huge costs. &