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Hagmueller: COVID-19's Impact on Insurance and Delivery of Care

By Gary Hagmueller

Tuesday, April 14, 2020 | 0

In just the past few weeks, two new forces have emerged that will reshape the workers’ comp system for years to come.

Gary Hagmueller

Gary Hagmueller

The first is the COVID-19 pandemic, which has now infected more than 1 million people globally, creating both sudden and deep shifts to personal health practices and health care delivery.

To reduce COVID-19’s impact, much of the U.S. population is avoiding public spaces and travel, causing enormous disruption across a range of industries, from airlines to hospitality. This change has ignited a second massive shift — a nearly 20% drop in the S&P 500 — and the sudden start of a global recession.

Together, COVID-19 and the accompanying recession are driving significant changes across property and casualty insurance lines, including workers’ compensation, causing carriers, reinsurers and third-party administrators to rethink long-held assumptions. Companies hoping to navigate all of this need to anticipate and prepare.

To help, we held a Q&A session with some of the smartest people in the business who sit on our advisory panel. Special thanks go to Dan Rufenacht, QBE North America; Will LaChapelle, QBE North America; David Bacon, QBE Insurance; Kevin Bingham, Chesapeake Employers’ Insurance Co.; and Jim Kinzie, QBE Insurance.

Below is a summary of responses outlining the most fundamental changes to plan for. Let us know what you think — and what your team and company are doing to adjust to this new and dynamic environment.

What are the major changes we should anticipate in workers’ compensation claims due to COVID-19?

The experts on our panel highlighted several ways that workers’ comp claims will change, many of which are related to shifts in volume and type of claim. For example, the total number of claims is likely to go down as unemployment increases. There are fewer people in the workforce, which will lead to fewer claims overall, particularly as work involving manual labor slows.

Although the volume of typical workers’ comp claims will decrease, claims for different types of injuries could escalate. There will almost certainly be an increase in occupational disease claims from workers on the front line of fighting COVID-19 (e.g., police, fire, health care workers, etc.).

There is emerging pressure in some states and regions/provinces to extend coverage for workers being asked by employers to extend services or responsibilities for essential businesses. There is also the potential for new ergonomic claims and other types of accidents as people adjust from working in an office to working from their bed or couch and sitting for prolonged periods.

Additionally, there is a risk for the select businesses hiring new workers: There could be an increase in frequency and severity of claims if workers are inexperienced or can’t be properly trained based on conditions.

On top of this, there may be some spikes in preventable accidents, resulting in new claims, if safety service visits have been canceled due to COVID-19, leaving potentially dangerous areas exposed.

Organizations should also expect to see several changes in treatment patterns emerge, as care delivery will undoubtedly be impacted under the strain COVID-19 places on health care systems.

Most non-essential surgeries, physical therapy sessions and scheduled doctor visits are tabled for the foreseeable future. This will delay the path to health for injured workers and delay the resolution of many claims.

However, telemedicine and telerehab solutions are being implemented in an attempt to mitigate the effects of delayed treatment. Key here with telehealth options will be ensuring that access to and the effectiveness of care delivered to injured workers remain similar to, if not greater than, the same care provided in-person with the treating doctor or therapist.

The shift to telemedicine and telerehab is an example of how present stresses are opening the doors for new innovations. Telehealth options and digital resistance that insurers and the larger health care community have been fighting over for years have suddenly become possible within the course of only a week because they are necessity driven. At least one panelist welcomed the opportunity, adding that “the old rules of ‘we can’t direct treatment’ are ripe for breaking just now.”

How are claims teams gearing up to handle these changes? Are there parallels that come to mind?

To prepare, claims teams are keeping a close eye on the new claims coming in — the type and volume — to ensure proper resourcing and reporting. New organization structures are also being considered.

For example, some organizations are considering bringing some of the claims processing that previously had been outsourced to places like India and the Philippines back in-house — and possibly permanently. The benefit of this move is to open new jobs at home, which can offer good flexibility as employees work remotely.

Also, based on behavior in past crises, the panel noted that claimants are under a lot of additional stress. Therefore, it is imperative that claims teams show empathy and compassion. We are all trying to navigate an unprecedented situation, and people are doing the best that they can.

Any impact on other types of claims due to the stresses on the health care environment?

Panelists instantly noted how much pressure first responders are under. These workers are covered in many states under presumption laws, which can include post-traumatic stress disorder. If so, according to our experts, there will likely be an increase in claims from first responders soon.

Any advice for claims professionals?

Panelists offered several thoughts, including:

  • Remember to stick to the basics. Conduct quality and complete investigations and thoughtful compensability evaluations. Use common sense and empathy and talk to peers and managers to manage stress and determine the best ways to help claimants.
  • Look for opportunities and new or different treatments and delivery channels that can provide relief in lieu of surgery, as almost all non-emergency surgeries have been postponed or canceled.
  • Watch how other lines indirectly and directly impact workers’ comp. For example, health insurers will be inundated with all kinds of pre-hospital, hospital and post-hospital expenses. If they can get workers’ comp to pay for these costs, it may become more important to them.

With things evolving on a daily basis, how do we keep abreast of all the changes going on? Are there any specific resources you use?

Our experts rely on several proven and reliable industry blogs, association websites, attorney newsletters, state bulletins and other alerts to stay on top of the industry — in addition to daily news broadcasts and updates. Some listen to podcasts as well. Sources include general business and technology in addition to verticals.

To help, we compiled a list of some of the most useful industry-specific content mentioned:

I would like to extend my great thanks to all of our advisory panel members for sharing their insights in this turbulent time.

Gary Hagmueller is chief executive officer of CLARA analytics.


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