How Can Carriers Tackle the Most Frequently Asked Questions in Workers’ Compensation Claims?

Nobody anticipates getting injured at work. When accidents happen, many questions arise: Will I still receive a paycheck? Will my employer cover my medical expenses? How will I pay my bills?

Carriers must promptly address inquiries to minimize uncertainties and mitigate the risk of disgruntled claimants. Otherwise, injured workers may seek legal counsel, which escalates costs significantly. Industry research shows that workers’ compensation claims that involve attorneys result

in 390 percent higher indemnity costs and last 295 percent longer than unrepresented claims. Improving communication and efficiency in the workers’ comp claims process will help reduce the risk of litigation, create better medical outcomes and get injured workers back to work faster.

By leveraging existing conversational data, insurance carriers can reveal the most frequently asked questions in workers’ comp. Understanding these inquiries provides an opportunity for improved clarity, responsiveness, and efficiency in the workers’ compensation claims process while helping the patient return to work and their livelihood faster.

Analysis

Hi Marley, the first intelligent conversational platform built for P&C insurance, aimed to uncover the most frequently asked questions in workers’ compensation claims.

We analyzed conversations from the workers’ compensation carrier customers within our platform, categorizing a relevant sample of inbound questions by the root cause of what drove the customer inquiry.

Key Findings

Workers’ compensation claims are uniquely sensitive and require special attention and care. However, in a recent survey, 60 percent of workers’ comp claims professionals said they had too many claims to manage. And 29 percent of survey participants said operational efficiency is challenging for the industry. Workers’ comp carriers need a way to streamline the claims process.

Hi Marley found that the majority of the frequently asked questions in our analysis could be handled through proactive outreach, automation and standardization of communications to help carriers:

• Manage expectations- Explain the process in the beginning and send automated updates throughout the process.
• Provide peace of mind- Set-up automatic payment updates to create a better experience.
• Show Empathy- Confirm receipt to help injured workers feel heard.
• Support faster recovery- Use predefined message templates to schedule reminders.

By automating processes and standardizing communication, carriers can eliminate repetitive, mundane tasks and improve efficiency and consistency while allowing claims staff to concentrate on activities requiring human touch and attention.

Support Faster Recovery: Use Predefined Text Message Templates for Scheduling Reminders

An injured worker’s road to recovery can be difficult. According to Travelers’s 2023 Injured Impact Report, injured workers miss 71-79 workdays on average. And, if an injured worker misses a doctor’s appointment or therapy, it can delay recovery time, further increasing the claim cycle time and costs.

In Hi Marley’s study, 22 percent of frequently asked questions related to provider inquiries, specifically about scheduling (47 percent) and approval activities (36 percent).

Carriers can leverage predefined text message templates to anticipate and address these frequently asked questions. In fact, 68 percent of workers’ comp claim professionals said that tools that automate certain claims processes are important for medical management programs.

Setting up automatic status updates and text messages to remind injured workers of upcoming appointments and routine checkups can save costs and help injured workers receive the proper treatment, maintain a routine and recover faster.

Manage Expectations: Explain the Process in the Beginning and Send Automated Updates Throughout the Process

Communication is one of the most common pain points in workers’ compensation claims. Workers’ comp is complex, and there needs to be more clarity around the claims process and what to expect if a worker suffers an injury.

The need for process explanation accounted for 14 percent of all inquiries in Hi Marley’s study. Among these questions, two out of every five pertained to clarifying the claim process, checking the claim status or verifying the claim number. Many injured workers share a sentiment expressed by one customer in a message to an adjuster: “I have pieces of information, but I am feeling uninformed about this process.”

Furthermore, due to the appointments, therapy and various treatments injured workers need for recovery, transportation needs are also considered during these claims.

Nine percent of inquiries pertained to specific benefits and what is covered, with the majority of those questions (41%) asking about mileage and parking reimbursement. For example, “What is the reimbursement rate for the miles?” or “I took Ubers and I have the receipts; will I get paid for my transportation?”

There’s an opportunity to proactively explain the entire workers’ compensation process up front, including what is compensable, what steps they need to take and how the injured worker will be reimbursed. By providing a clear explanation in the beginning, the adjuster can proactively answer questions, reduce inbound inquiries and help manage expectations.

The carrier can also create automated messaging around claim status to be proactively sent at strategic points throughout the life of the claim, such as approval for additional therapy or by hitting a milestone in their recovery.

Provide Peace of Mind: Automatic Payment Updates Can Create a Better Experience

The top root cause for customer inquiries centered around payments (26 percent). The most common inquiry categories that required further explanation include:

Providing an update on the check status and amount would solve the top payment inquiry. For example, automatic payment status notifications that confirm the payment, what it covers, and how they will receive it would reduce a significant number of initial and ongoing inquiries from injured workers regarding payment.

Every time a payment is issued, the customer could receive an automatic text saying money is on its way, along with the payment amount and a link to see a breakdown of the amount calculation. This is just one way that automation can help speed up the workers’ comp claims process, ultimately creating a better claims experience and improving outcomes for all parties.

Show Empathy: Confirming Receipt Helps Injured Workers Feel Heard

Injured workers face financial strain, uncertainties about recovery, and the prospect of supporting themselves and their families while injured.

For example, one injured worker wrote to their adjuster, “I don’t know how any of this workers’ comp stuff works. If the pain is too bad do I need to go back in to doctor again? Am I going to lose my job if I don’t make it to work? I’m just worried about losing my job about doing more damage and about money. I don’t know what to do with anything.”

Workers’ comp claims adjusters play a crucial role in delivering compassionate and clear communication. They are, after all, the injured worker’s link to understanding the process, expectations and responsibilities.

Requests for contact, the second most popular reason customers reached out to adjusters, accounted for 24 percent of all inquiries.

Injured workers need support and want to feel heard. For example, a customer texted their adjuster, “Just sent you a document. Can you confirm you received it?” These types of messages underscore the need for empathy and understanding in communications with customers.

A simple note confirming a document was received goes a long way for customers’ feeling of being heard and understood, impacting their sense of security and well-being.

Carriers can address the most frequently asked questions and improve communication in workers’ comp claims by explaining the process up front, automating and standardizing messaging where possible, and providing regular updates. By combining automation, clear communication and empathy, carriers can improve outcomes, streamline the process, and provide much-needed support to injured workers on their recovery journey.

To learn more, download the complete white paper “Combining Automation and Empathy: How Carriers Can Tackle the Most Frequently Asked Questions in Workers’ Compensation Claims.”