May 2019 – CLHIA in Vancouver

About 18 months ago we started working with Empire Life and MunichRe in Canada on an exciting new joint project. This blog is a case study that our two clients presented at the Canadian Life & Health Insurance Association meeting earlier this month.

We would like to say a special thank you to Sheila Karras and Stacey Ramirez for working so hard on this project!

I hope you find this write up thought provoking.

Stacey Ramirez
Director Disability Claims and Strategic Initiatives, MunichRe

Art and Science
At MunichRe, we often talk of claims management as an art that is transitioning to a science. We are the art – as case managers we are trained to review, assess and request the right information. There is a feeling claims managers get, when we know more information is needed, that something else is going on with a claimant, and acting on it.

Then there is the science. Is there a formula to disability management? We all know there is, but how do we put this into a calculation or a process that an actuary or data scientist can identify with? This is what we’re trying to do more of, bringing both together.

Combining the art and the science would make for better outcomes, but how do we do this?

Richer Data
Empire is using a new tool from The Claim Lab. It’s an exciting way to help you learn more about the claimant and employer. Questionnaires are sent to claimants and their employers to capture psychosocial information and together with analytical models, the tool provides scores for claim managers and for analytics. It will help you target your telephone interviews more efficiently, inform your decisions and action plans to help manage your work, and produce quicker resolutions for your claims.

Sheila Karras
Director of Group Life and Disability Claims. Empire Life

The Process
The Claim Lab’s tool allows us to capture and analyze data directly from a claimant, and an employer. The questionnaires focus on the wider factors not entered on a claim form: psychosocial factors.

We apply The Claim Lab questionnaires to new LTD claims, prior to adjudication, to drive the agenda for the telephone interview. This helps reduce the time spent on telephone interviews, makes them more focused, and helps our less experienced claim managers get the right information.

Previously we found that less experienced claim managers were not asking the hard questions and the follow-up questions. The questionnaires assess claimant motivation, workplace issues, domestic problems, and also measures the mental health of the individual.

The Project
The Claim Lab helped us understand the scores and graphics, highlighting unusual claims profiles as they occur, and discuss the causes. They also provide deep analysis of data and great reporting.

The initial introductory process is very important, claimants need to know it’s a real Empire e-mail and it needs to set their expectations for the claim adjudication procedure.

Change management has been a significant issue on this project, and we have gone to great lengths to help support the introduction of the new process. We ran competitions to engage managers, rewarding success, and encouraging improvement.

From the analytical viewpoint, we are getting a consistent, quantifiable measure of a claimant’s capacity, their mental health and their motivation, we have found these factors to be very revealing for the claim process.

Times on telephone interviews have reduced, claim managers are now more focused, and we are making better informed claim decisions.
The Claim Lab is looking for disability & workers compensation insurers in Canada, the US and Australia to help with the pilot program, so if you are interested, please email info@claimlab.org