Put yourself in my shoes
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It isn’t easy to understand what an injured worker goes through during the claims process, but it's crucial to a good outcome with lasting results
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GOING THROUGH a workers' compensation claim is a process in which the person most affected generally knows the least about what is happening. The injury can throw the person’s life into turmoil, threatening their livelihood, future financial security, and mental and physical health.
To be truly customer-centric, the people involved on the insurance side need to put themselves in the shoes of the injured worker, says Ella Jurotte, Duck Creek Technologies product manager Asia Pacific.
“[The person] is all of a sudden thrust front and centre into a very well-oiled machine, a well-established practice where they realise that everyone around them already knows what’s going on except for them,” she says.
The injured worker is connected with a person in charge of the claim, who asks for details about who they are as a
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Number of workplace injuries FY2006-18
2005/06
689,500
“You’re ultimately responsible for being a guardian over that [injured] person and their needs and doing what you can to return them to the best possible life that they can have”
Ella Jurotte,
Duck Creek Technologies
person, their life, and their personal medical history at a time when the injury is still fresh or painful.
“Think about what this feels like – and not only that but [they are asked questions like] when are you going to go back to work? Do you think you will ever go back to work? Do you think you can perform suitable duties?”
Most people would not know what the term 'suitable duties' means in the context of the claim, Jurotte says. The situation can quickly become overwhelming as the blunt reality that the injured person’s life may have changed forever dawns on them.
“If you are physically in pain, or sick or distressed, suffering from an injury or illness, you can’t separate yourself from that situation because you are the situation,” she says.
A different kind of animal
Workers’ compensation is not like a motor vehicle claim or contents insurance, when the insured person will have considered a range of options and thought about what their ideal outcome would be if they ever needed to make a claim.
“With workers' compensation and other similar statutory accident compensation schemes, the injured worker or person isn’t generally the individual who instigated the insurance cover, so their awareness of what’s required, what they’re
entitled to, what support they will receive is an unknown entity,” says Jurotte.
This places a responsibility on the insurer that is larger than often realised.
“You’re ultimately responsible for being a guardian over that person and their needs and doing what you can to return them to the best possible life that they can have,” she says.
With injuries at work, measuring whether the process has been a success is also more challenging, because each injury is different, and the people involved are unique, with differing recovery narratives. Recovery is not a linear process, and things can suddenly go backwards just when they appeared to be improving.
“Ultimately the intention of the scheme is to get people off claim and get them back to work, in collaboration with the extended team – employer, treating doctor, allied health professionals, family – but there’s huge opportunity to look at how we measure success,” says Jurotte.
There also tends to be an assumption of moving towards recovery as a goal, which is sometimes not the same as healing, she says.
Insurers are often aware of the higher bar needed for customer service when it comes to workers’ compensation, and many have invested a lot of time and resources in improving the customer experience to make it more empathetic.
But Jurotte says there is still a disjunction in terms of how scheme regulators measure and remunerate insurers who manage claims on their behalf. Limiting the measure of success to whether the person returns to work or not downplays the critical factor of quality of life.
Jurotte says this kind of attitude stops insurers and agents from achieving better results, and more guidance is needed.
“The cultural change needs to come from the top.”
A magical mental shoehorn
There are a number of common pitfalls for those dealing with workers’ compensation claims, though their approach may be well intentioned. One example is when a claims handler tries to understand the injured worker's situation by comparing it to a similar personal experience. It is human nature to respond to another’s plight with an I-know-how-you-feel reaction, because a similar personal experience is a shortcut to generating empathy.
Jurotte says this can help to a degree but plasters over the problem at hand by dressing it up with colours that were not there originally.
“Understanding the customer is a journey, not a destination”
Ella Jurotte,
Duck Creek Technologies
An eye on the future
Over the next five years, both Sree and Smith fear that social inflation and large jury awards could impact pricing and risk selection in the nonprofit space. Smith cautions that we’re not out of the woods yet with COVID-19 litigation, which is something Convelo is watching closely.
Davis points to cyber as another key issue nonprofits will have to tackle.
“I think cybersecurity is going to be a challenge for the whole industry and is something that we pay really, really careful
“Understanding the customer is a journey, not a destination," says Jurotte.
It is a very difficult thing for a claims handler to put themselves in 50 different pairs of shoes if they have 50 cases, when those shoes are constantly changing size, colour, style and comfort level. It is almost as if each handler needs to have a magic mental shoehorn to perform optimally.
“It's an ever-evolving landscape that’s impacted by technology, expectations of individuals and organisations, environment, culture, political climate,” says Jurotte.
Duck Creek has advanced systems designed to support the claims process, and the science side of things is certainly stronger due to recent advances in this area.
“This is where digital insurance supported by machine learning and artificial, or rather augmented intelligence really comes into its own.”
But the rise of digital tools should enhance the human role rather than substitute it. Having robust technology allows the people involved in the process to focus on the things that only humans can do – like fitting themselves into 50 different pairs of mental footwear.
“The case manager on the end of the phone and the team they have around them to support them in the process, they are the artists of the human engagement in the injured worker’s story.”
Having the customer at the heart of the process in this manner is the standard at Duck Creek, Jurotte says. Only this level of commitment can achieve real and lasting results.
Number of serious workers' compensation claims by occupation, 2017/18
Share
Share
2009/10
640,700
2013/14
531,800
2017/18
563,600
“It can also be problematic, because they might start projecting their own outcome and recovery journey on [the injured worker].”
Like recovery for the injured person, truly understanding their situation is a process that continues with ebbs and flows as circumstances change and the worker is pulled in different directions by the injury and other things happening in their life.
Machinery operators and drivers
15,280
Technicians and trades workers
17,330
Clerical and administrative workers
4,355
Community and personal service workers
18,895
Labourers
27,140
Professionals
10,960
Managers
4,405
Salesworkers
6,390
Source: Safe Work Australia 2020
Source: ABS 2019
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People
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Contact us
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Asia
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AU
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