February 2025 – Duration Guidelines for Psychosocial
How about managing psychosocial factors!
The longer any claim remains open, the less it has to do with the original medical condition. While medical recovery is often measured on a 6-month timeline—where the majority of conditions improve or resolve during this period—Longer term claims frequently tell a different story.
For many conditions, individuals recover within a 6-month time frame. So why are so many individuals still unable to return to work when they reach the start of a longer-term policy? The answer, of course, is that claim duration isn’t related to the complexity of the medical condition. Yes, some health issues, like brain injuries, and some cancers can take years to recover from or remain chronic conditions, but for the majority of cases, the barriers to recovery are more often psychosocial than physiological.
After being out of work for 6 months, there are often deeper, underlying factors at play—factors that prevent individuals from returning to work (RTW). This is where psychosocial elements come into focus. Through the use of carefully designed Questionnaires, we can measure and score these variables early in the claims process.
The data from these assessments consistently shows that claims with higher psychosocial risk scores tend to have longer durations. In fact, the data allows us to predict with reasonable accuracy which claims are at risk of becoming long-term, right from the start.
Remarkably, we achieve high completion rates for these Questionnaires, typically ranging between 70% and 90% and the prompt completion of questionnaires – within 2 days. This means we are able to gather a wealth of data early on, that can help flag potential challenges. From there, claims teams can tailor their approach and intervene early to address the psychosocial barriers highlighted by the data.
By segmenting claims based on their psychosocial risk profiles, claims teams can apply different processes for claims with varying levels of complexity. For the small number of high-risk claims, a high-touch claims management model becomes essential. Carriers who have adopted this model have seen outstanding results—shorter claim durations, fewer unnecessary interventions, and, ultimately, more accurate predictions for managing complex claims.
Let’s look at an example of one of these factors. An individual’s motivation is highly predictive of claim duration. This is evident when we examine the chart below.
The chart groups claims into four distinct motivation levels, each displaying the average duration for that particular group. A higher score on the motivation scale correlates with poor motivation, which is associated with longer claim durations.
We can notice the difference in duration when looking at the height of the dark blue bar (low motivation issues) with the height of the red bar (highest level of motivation issues). Claims in the red bar take more than twice as long on average to resolve as those in the blue bar.
By understanding the motivation score of the claimant at the beginning of the claim process, it allows us to gain valuable insight into how long the claim is likely to extend, without proactive actions to address underlying factors. Motivation proves to be a highly significant indicator in the ultimate duration of the claim.
Yes, The Claim Lab has a predictive model to provide duration guidelines for Psychosocial Factors!
So, what can we do about these factors once they are identified?
In next month’s newsletter, we’ll take a deeper dive into the concept of a high-touch claims management model. Dr. Kristin Tugman, who is a consultant, has a PhD in psychology, and is a long-time friend of The Claim Lab, will introduce a methodology that can transform how claims teams manage complex claims. Stay tuned for insights that could revolutionize your approach to claims management.
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