Rising Medical Solutions recently published their annual work comp benchmark study, which looks at the problems and issues in workers’ comp and might give us a better handle on how we can address those hurdles. This study looks at a few topics like measurement practices, staff and turnover, use of technology, use of analytics, use of incentives for your operation or your partners and prioritizing the core competencies of your system.

The study utilized a survey compiled by an independent research with 60 questions. They got responses from over 258 participants made up of claims managers, directors and executives. 30% of respondents were from an insurance company, 24% were from a self-insured, 14% from a TPA, 12% were employers, 10% worked at a government entity, 4% were from a risk pool, 2% were at a state fund, reinsurance companies were represented with 1% of respondents and 2% said they were “other”.

Though we encourage you to take a look at the full report, here are some of the stats we found most interesting when it comes to the claims staff and systems. We have been highlighting adjusters this year and the results of this study suggest that adjusters are still overwhelmed and undertrained.

When it comes to their staff

–          Less than half (49%) of the participants provided technical training and development for senior-level claims adjusters, while less than half (42%) had a formal training program for their new hire claims staff

–          On average claims adjusters access 3-7 different systems in their daily workday

–          70% of respondents said they considered 1-2 systems to be the most efficient for their claims adjusters to use on a daily basis, yet only 38% only had 1-2 systems. The rest had 3, 4, 5, 6 or more

–          Only 65% of those who responded that they even have a training program (remember, 42% of the total sample had training programs for new hires) said that they thought the length of their training period prepared their adjusters well enough to handle a case load

How much time do you think is appropriate to train new hires before they are ready to take on a case load? A lot of times organizations will claim that cost is a big factor in their decision to have more minimal training programs. A better trained adjuster might end up returning that cost if they can close claims faster and they have more training to do so.

When it comes to systems integration

–          A third of participants reported that NO integration exists between their core claims system and their ancillary systems. They reported that their manual copy-and-paste transfer of information is “integrated”

–          A little over a third (34%) of participants said that none of the following kinds of systems were integrated into their claims system

o   Bill review

o   Nurse case management

o   Pharmacy benefit manager

o   Utilization review

o   Providers networks

o   Fraud and abuse detection

o   Predictive modeling

What this study is telling me is that organizations are sending their adjusters out on the front lines with limited integrated systems and little training. Based on what we’ve seen our adjusters do, maybe it’s time for companies to think about changing their M.O.