The icare Claims Management Model – Analytics insights

In early 2018 icare launched a segmented claims management model which is designed to help ensure that all customers get the best level of service and care appropriate to their needs. 

At the heart of the model is the drive to deliver better return to work outcomes. This is an outcome of providing the right level of care and support relative to the needs of the injured worker and proactive liaison with employers to ensure suitable return to work plans are in place. 

icare has engaged EML to deliver on this goal.

Claims lodgement 24/7

Claims can be lodged through our online portal at a time that suits our customers, any time of day. About 60% of our customers are choosing to lodge claims this way. Alternatively, customers can lodge a claim by phoning the support centre.  The Claims Support Centre operates from 7am to 7pm Monday to Friday, to provide support for customers to lodge claims with our Claims Advisors. Claims can also be lodged via email or post if preferred.

In the six months to the end of June 2018, we received more than 31,300 new claims and a further 7,000 injury notifications (i.e. reports of injury as required by legislation that don’t incur time lost or medical expenses).

Customer feedback

Although the model is still relatively new, Net Promoter Scores have been trending upwards. Below is a selection of comments from customers:

  • “Fast, efficient and very helpful” (worker)
  • “Handled efficiently” (employer)
  • “Excellent customer service and hassle-free claiming process” (worker)
  • “Very easy to make claim & good feedback” (employer)
  • “Amazing service, I always had all the doubts clarified at every call’ (worker)
  • “Customer service has been extremely personable and my case manager was so caring” (worker)

We appreciate the positive comments but also received feedback on our key areas to improve. Our focus areas for improvement based on customer feedback include:

  • Better management of email communication, including document handling
  • Payments and decision making in a timely manner
  • We continue to focus on reducing call wait times and the ability to contact claims teams
Customer feedback  - NPS value of 6 as at 30 April (30 day view)  NPS value of 13 as at 30 June (30 day view)

Communicating with customers

Communications with employers and injured workers is a cornerstone of the claims model. There are several channels available to communicate with our teams, including email, mail and through the online portal. By far the most popular communication channel is telephone, with over 55,000 inbound and outbound calls being handled each month.

Since the beginning of January, the average time to answer inbound calls has significantly reduced, reflecting the focus we have on ensuring our customers can get the help and assistance they need.

average speed of answer has dropped from 8.48 minutes in February to 1.40 minutes in June 2018
The number of outbound calls has also been steadily increasing, reflecting the proactive nature of our communication processes and higher claims volumes. These can include HUG calls (see below) and follow up calls with employers, injured workers and other providers in order to ensure we are meeting our promises and proactively managing claims.

Return to work outcomes

Early indications of performance based on a 13 - week duration metric show positive trends and are in line with Scheme performance over similar periods last year. As claims mature along with associated payments, weekly benefit payments and finalisations, it is expected that results will continue to improve and stabilise.  As these trends become available we will share them in future reports. 

Claims lodgement

Our portal analytics provides some insights on what is known at the time of lodgement: 
Pie chart showing who is submitting claims online.  85% of the total lodgements were submitted by Employers, 8% of the total lodgements were submitted by Third Party Representatives, 7% of the total lodgements were submitted by the Injured Person
  • 52% of the total lodgements Required Time Off Work
  • 97% of the total lodgements Required Medical Treatment
  • Top 3 general body parts injured were Arms (includes shoulders & hands), Legs (includes Hips & Feet), and Back
    • The top 3 types of injury were topped by Lower back pain/strain, followed by Shoulder pain/strain, and then by Finger cut/laceration 

How You Going (HUG) calls

A new feature of the model is more proactive communication with customers. Every claim lodged triggers a HUG call for injured workers and employers. The HUG call helps to reassure customers during the claims process, to identify potential issues, and make sure customers are getting the level of assistance and care they need. All of which help to improve return to work outcomes.

Over 33,200 HUG calls have been made in the first 6 months, and our target is to have made a HUG calls for each claim within 2 working days of lodgement. We are now in an operating rhythm where this is occurring in the vast majority of cases.   

Chart showing weekly task movements for HUG calls. Week of 8 April 2018 2400 calls completed in week - Week of 15 April 2018 1700 calls completed in week - Week of 22 April 2018 2100 calls completed in week - Week of 29 April 2018 1500 calls completed in week - Week of 6 May 2018 1200 calls completed in week - Week of 13 May 2018 1400 calls completed in week - Week of 20 May 2018 1400 calls completed in week - Week of 27 May 2018 1600 calls completed in week - Week of 3 June 2018 1600 calls completed in week  - Week of 10 June 2018 2500 calls completed in week - Week of 17 June 2018 1000 calls completed in week - Week of 24 June 2018 1400 calls completed in week -Week of 1 July 2018 1700 calls completed in week

Liability decisions

The promptness of making first liability decisions is an important indication of the effectiveness of the process. Early intervention is key to the injured worker receiving treatment as quickly as possible to support their return to work.  

The graph illustrates that 99 per cent of the first liability decisions are made within 7 working days.   

Scheme percentage pass of First liability decisions within 7 days has been between 90 and 95 percent  in 2017. In 2018 as part of EML the percentage pass has been between 95 and 100 percent.

Customer complaints and disputes

As a consequence of moving the Scheme from an adversarial to an empathetic model, it is expected that the volume of disputes in the Scheme will reduce. icare has implemented a new complaints and disputes framework to provide better oversight of complaints and disputes that will allow better identification and resolution of root causes of complaints and disputes.

There were 11 per cent fewer dispute applications lodged in the Workers Compensation Commission in the first 3 months of 2018 compared to the same time last year. This can be attributed to the positive action taken by the icare complaints resolution team that ensures timely responses to complaints, leading to fewer complaints being escalated to dispute level.

In May, 21 applications for review of disputes were lodged with icare for review regarding liability and PIAWE decisions. By the end of May, five disputes were escalated to the Workers Compensation Commission for resolution.