Benefits of the new claims model

Elizabeth Uehling, General Manager, Return To Work and Support, outlines the benefits that employers and workers will see when the new claims model launches from 1 January 2018.

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Delivering a new world-class claims service

Our next major strategic step in transforming the workers insurance claims experience will begin on 1 January 2018, when new claims will be managed in our re-designed claims model with EML as our appointed claims service provider. We're embarking on a unique partnering relationship where we'll bring together the best of the strategic focus, oversight and direction of icare with the operational excellence of EML.

The new model is focused on achieving optimal outcomes for all our customers where highly capable specialist teams will deliver a service that is aligned to the needs of employers and workers. This will be enabled by new technology that allows the specialist to provide the best support and outcomes for each claim.

How will it be better?

Our goal is to make the claims process simpler, transparent and effective, which is why we've developed a claims model that ensures appropriate levels of support and management are matched to the circumstances and complexities of the claim. Our triage process (a mix of automation and human expertise) will quickly direct claims to the right specialist, meaning injured workers quickly get the treatment to help their return to work and health.

What will the new claims model deliver?

Notifying an injury

A new online notification portal will make it simple to notify us of an injury and allow the triage of a claim to begin quickly. It’s intuitive with plenty of online assistance to make it as easy as possible to use. It’s simple to upload supporting documents at any point in the process, even after the notification has been submitted. Employers, workers and third parties can use the portal, but if they prefer, they can choose to contact EML by email or phone to speak to a case manager for assistance.

Right level of support

At the core of our model is the principle that the worker and employer will quickly be assigned the right level of support for their circumstances.

Through the questions asked and answered in the notification portal, we'll be able to quickly allocate the claim to a specialist who is most capable of providing the employer and worker the support they need. icare and EML have developed a sophisticated set of triage rules which are both system and human managed.

For instance, if the claim is non-complex, such as a medical-only claim, we can reduce the intervention levels required and deliver a faster resolution. More complex claims, however, can be quickly assigned to highly-trained and experienced specialist case managers.

Throughout the claim lifecycle there are a number of flags that will alert our teams around the complexity and progress of the claim. We have a dynamic case management and triage review process that applies throughout the model. If additional factors are identified that could require further investigation for a potential change of support needed, we'll instigate a review of the claim. This may involve an Injury Management Specialist, Triage Specialist, Case Management Specialist, Technical Specialist and Team Leader if required.

If appropriate, the injured worker may be moved to a higher level of support immediately. No customers will be transitioned to a lower level of care.

Return to Work (RTW) outcomes

While more than 75% of claims are closed within 4 to 6 weeks of the date of notification, key to improving this outcome is the rapid agreement of provisional liability. Provisional liability will be accepted very quickly for injuries which are low risk and the employer agrees that the injury is as the result of work. This will enable the worker to get appropriate treatment or support much faster. By getting faster access to treatment, the RTW time will often be improved.

Where there is more complexity associated with the claim or the circumstances of the injury, a Specialist will be supported by a Technical Specialist and will gather sufficient information to make a soundly-based decision. Each liability decision will take into account the individual circumstances of the claim.

Better Communications

One of the consistent historical pieces of feedback about claims management has been around poor communication. In the new model, the first thing customers will find different is the immediate allocation of a seven-digit case number. This can be used by injured workers when visiting GPs or treatment providers to ensure they get treatment approved quickly. After notifying us of an injury, both the injured worker and employer will receive a phone call to ensure we have all the relevant information we need and to explain the next steps in the process. There are also proactive communications scheduled throughout the lifecycle of the claim based on events or time triggers. In addition, we're introducing personalised videos for injured workers to explain the process to them and to let them know what support they will receive.

There are many further enhancements to the model in the pipeline for 2018 that will deliver more transparency and empowerment for employers and injured workers.

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