Finding “Magic” in the Claims Mix

By Gary Anderberg, PhD, Senior Vice President, Analytics, Gallagher Bassett

Most disability cases — occupational and nonoccupational — resolve normally without intervention. But 10% to 15% of cases need additional attention to avoid becoming long-term claims. Organizations have developed tools — from simple paper-and-pencil lists to artificial intelligence (AI) applications — to identify potential outliers early in the process. In some cases, the most powerful tools are preventive efforts (to ensure worker safety) and effective communication.

The following three approaches to claims management complement those efforts and include suggestions for identifying claimants who need additional support.

A Low-Tech Approach

A major Midwestern multi-campus medical center with about 36,000 employees reduced overall claim costs for occupational and nonoccupational disability events by more than 30% using a simple checklist. It included about 20 diagnoses with questions (such as the presence of comorbid conditions) that adjusters should ask claimants and/or treating physicians. Each question had three or four possible answers with point values. A nurse case manager was assigned if the point tally exceeded a certain number. The list represented the cumulative experience of the adjuster team with advice from case management nurses and friendly physicians, so the total development cost was a few pots of coffee and possibly a dozen donuts. Forms were printed on an office copier, the claims team was responsible for the checklist, and everyone pitched in and used it consistently. After the checklist was deployed, the claims experience improved and remained approximately 30% lower than the previous baseline for several years, according to the employer’s disability manager, who shared the success story at an industry conference.

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