Insurers who offer income protection policies can go on paying a replacement income for a long time. In fact as long as the claimant remains offwork, the insurer keeps paying up. But what if the policyholder was able to return to work, but had not received prompt medical treatment? What if physiotherapy could help or what if they could not return to a previous job, but were happy to consider another career. The insurance company could save a fortune in claims payments.
Crawford THG, the firm of loss adjusters, now has a healthcare division which it says could save insurers millions of pounds a year. Care management is already well established in the US. It is used widely in creditor insurance claims, when the policyholder is unemployed or sick and the insurer is exposed to claims to cover loans or mortgages. It can also be used for a variety of claims cases such as employers’ liability, motor and long term care.
In the UK, Crawford THG healthcare division is working largely on income protection claims for several leading insurers.
Crawford THG’s healthcare division is headed by Deborah Edwards, a warm and friendly woman from the American South who is a qualified nurse.
She has a naturally sympathetic manner and explains it takes a special kind of person to visit a sick or injured person in their home and find out why they are unable to return to work. It is a job which requires medical knowledge, persistence and tact.
In the UK, Edwards now heads a team of specialists including nurses, occupational therapists, occupational psychologists and career development workers. While the nurses have medical experience, and act as case managers, the other staff are classed as vocational case managers. Most claimants will be allocated a medical and/or vocational case manager.
Edwards says sensitivity is used at all times when communicating with claimants.
She denies that claimants, many of whom maybe seriously injured, resent the intervention of Crawford THG. “Our nurses are very sensitive people. They work from a clinical base, are educated and with strong people skills. They need to be able to communicate at all levels. They are motivated and able to think on their feet.”
She is anxious to stress that while insurers pay for Crawford THG’s assessments, these are made on a strictly impartial basis. “We are there to intervene objectively,” she says.
Edwards adds that if a claimant is too disabled ever to return to work her staff will tell the insurer. “We wouldn’t risk that person sustaining injury. We act as an impartial third party.”
That said, insurers will over the long term will want to see a return on their investment and she says this can be shown not so much from a case by case experience, but from over a longer period such a year.
And from US experience, insurers can see the intervention of Crawford THG has resulted in a significant number of claimants returning to work quite soon after the first contact is made. Just one telephone call can bring significant savings. “There is no doubt that all insurers have found that their average exposures went down,” she says.
Despite the gentle approach, the aim is to give claimants a structured and comprehensive assessment, with treatment recommendations and follow-up visits to make sure this is being adhered to.
“Our job is to ensure the injured or sick person receives the highest quality of care within the parameters of their policy,” she explains. The aim is also to make sure contact is made early.
The first approach from Crawford THG is made via a phonecall which is then likely to be followed up by a face-to-face meeting. Edwards explains early notification of a claim is vital if they are to make a real difference. “We like to step in within 48 hours if possible,” she says.
The claimant’s doctor will be kept fully informed of Crawford THG’s work. Edwards says doctors who are normally too busy to make such thorough investigations of the work situation are usually supportive and grateful for new information. “They often will just not have had time to assess a situation,” she explains.
But she adds: “It is not our role to make a new diagnosis. We will speak to them as a nurse to a doctor. We are there to assist the claimant and provide the doctor with more knowledge.
We will let them know about a recommendation for work modification or extra private care which will expedite a return to work.”
There is no escaping there is a big brother element in care management, even if it is in the claimant’s best interests. “Even though a doctor may have recommended a course of treatment, the patient may not follow it. We will check up to make there is compliance of that treatment,” she says.
Sometimes the problem is not just physical. Stress can often by a major causation factor, with symptoms masking deep depression and anxiety.
Edwards says the care manager may notice that the dishes are piling up in a claimant’s sink, that the house is dirty and that the lawn is overgrown. While the claimant maybe complaining most about a back ailment, depression could be at the root of the problem. This may lead to help from a vocational case manager, who can recommend psychological care such as counselling. Crawford THG Healthcare is growing fast in the UK. Set up from scratch, the division is now rapidly recruiting staff. Advertisements in the professional press target nurses and physiotherapists among others to join the team. Once appointed, they receive in-house training, learning the ins and outs of the insurance industry and gain a legal understanding. People skills are absolutely vital and as Edwards says: “Nurses who enjoy hands-on patient care would hate what we do.”
Care managers also receive a grounding in legal matters. In the US, litigation is a way of life. In the UK, despite the growth of no win-no fee legal cases, it is still some way behind. Edwards points out that the intervention of a care management professional can prevent litigation recommending the right course of action to alleviate a condition and acting as a channel of communication for the employer.
And at a more simplistic level, it can also make sure someone who is fit to return to work does so without delay. But Edwards is quick to point out that the workshy are few and far between, and the incidence of this behaviour has reduced.
Even so, once Crawford THG is on the case, the game is often up. Very often, this happens without difficulty. “The fact the claimant knows they have a care manager is motivating in itself,” she says.
When a care manager meets with an aggressive claimant, she claims it is frustrating – but more a symptom of their situation.
A word she uses to describe the work of her team is “sentinel”. This watchman like approach has been proven to work and looks likely to become accepted practice in this country for insurance claims.
Beyond the private sector, an individual on state benefits in the UK could receive these for years before they are assessed to this degree, if at all, while in the US, care management is an accepted solution.
With talk of reducing the dependency culture over here, the work of Crawford THG would surely be of interest to the Government. While this may happen in the future, for now insurers can already access care management of the highest quality and substantially reduce their claims costs.