Just as other personal injury claims, workers’ compensation claims also hinge on medical chart reviews as a solid way to establish the injury and its intensity. The benefits paid by workers’ compensation insurance provide support during your injury and recovery. Given the significance of this benefit scheme, employees, employers, and insurers keep a close watch on the trends in the workers’ compensation industry.
Panellists on a webcast sponsored by Marsh’s Workers’ Compensation Center of Excellence (COE) had pointed out that the workers’ compensation insurance market conditions were favorable in the 3rd quarter of 2018 and are expected to continue through the rest of the year and into 2019. Overall, the workers’ compensation pricing fell by nearly 5% compared to the 6.1% average drop in the previous quarter. More than half of the total number of buyers renewed with rate decreases whereas 26% saw increases in their rates. Positive developments over the last few years such as declines in average loss rates and lost-time claim frequency, and slowing down in the pace of claim severity increases have contributed to the favorable pricing trend.
Experts say that value-based care, political party changes in many states, and a more holistic view of patient injuries will have an impact on the workers’ compensation industry in 2019. Here are some trends to watch out for, according to experts.
- Except 14 states, all other U.S. states have adopted Medicaid expansion and this trend is expected to continue through 2019. A major priority in 2019 would be addressing prescription drug costs. Physician-led ACOs (Accountable Care Organizations) have been doing well and are likely to increase in 2019. Providers receive rewards from the ACOs for positive patient outcomes.
- Political developments could have a major impact on workers’ compensation in 2019. The November 2018 elections saw the party of the governor changing in 8 states. These governors appoint the workers’ compensation regulators and administrative law judges, who have a significant influence on the practice of workers’ compensation in their respective states. More than a hundred national bills were introduced in 2018 to expand presumptions for first responders, and many of these bills pertained to post-traumatic stress disorder. This trend is likely to continue this year. There could also be a drive to continue death benefits for surviving spouses of first responders after remarriage.
- There could be increased focus on treating the emotional and psychological aspects of pain. A more meaningful and holistic treatment plan can be created if a patient’s response to pain is understood at an earlier stage in the claims process. The workers’ compensation industry could witness new developments in pain treatment such as:
- Creation of a pain philosophy as part of the claims program
- Implementation of initial and continuing pain evaluation tools
- Clearer and more frequent communication with the injured employee
- Increased transparency and empathy
- Making available the services of a pain psychologist or clinical pain expert to help guide more complex cases
- Focus on holistic pain treatment
- States will be focusing on the purpose of the AMA impairment guidelines in their state. The AMA 6th edition is a great tool to provide a measurement of objective physical impairment. However, it does not measure loss of access to the labor market, possible loss of earning capacity and other subjective elements unrelated to recovery from the physical injury. States will have to concentrate on whether subjective factors should be considered in permanent impairment ratings.
- Another area of increased focus will be social determinants of health. These determinants include education, socioeconomic status, literacy, access to health services, and healthy foods. The industry is very likely to examine the effect loneliness, safe housing, job, and transportation concerns have on an injured worker’s ability to heal and return to work. Many insurers are already addressing these concerns by providing meal replacement delivery services after surgery and also caregiver services for food preparation and companionship.
- Employers will be trying out new employee health models, with the understanding that the health of an employee is directly related to productivity. Since health insurers are not negotiating and managing costs in a way that employers can directly manage models, new employee health models are evolving with employer-purchased care. According to the National Business Group on Health, more than 50% of employers report having some form of value-based care in their health insurance program. More than 95% of large employers provide telemedicine solutions, and consumers who utilize telemedicine report a high level of confidence and satisfaction in their care.
- An aging workforce is contributing to an exceptional amount of turnover in the industry. There is the need to train and prepare the next generation of claims handlers. Training programs will have to be examined to ensure they are properly preparing people with the necessary skill sets to handle claims. Apart from learning the statutes and rules, training in soft skills is most important.
- Employee expectations, talent war, and state/local laws are persuading more employers to implement leave of absence programs. Those employers offering paid leave say that the benefit helps with employee retention and reduces turnover and employee training costs. The federal Tax Cuts and Jobs Act of 2017 that contains a tax credit for employers who provide qualifying types of paid leave to full- and part-time employees is also a factor that contributes to leave policies. With increasing implementation of such leave programs, the coordination of leave administration with job accommodations and workers’ compensation will be a trend to watch.
- Risk management is becoming more globalized in today’s global economy and employers with businesses in multiple countries have to address challenges associated with globalization such as compliance with a number of laws and regulations. Even businesses with only an online presence or those that work with vendors in other countries will be affected by the different rules and regulations.
- Disaster planning and response will have to become an essential part of a risk manager’s job with the increasing number of catastrophic natural disasters. Current risk management programs will have to be evaluated and modified if necessary.
Evolving trends in the workers’ compensation industry are closely watched not only by employees, employers and insurers but also by workers’ compensation lawyers and companies providing medical review service. To adapt to the new trends, organizations may be looking at various components of their existing systems and integrate newer technologies that can help improve their processes. There is no doubt that the evolving tech-savvy workforce and the numerous technological advancements will transform the workers’ compensation system and all stakeholders will have to be ready for those changes.
