February 2016 – New Insight into Permanently & Totally Disabled

The use of automated questionnaires to check the well-being of long term claims could provide new insight into severe and complex claims.

Typically most LTD claims operations will have an active caseload of 80 to 120 claims per claim manager. For claims that appear to be longer term, a separate unit operates. This unit takes these longer term or ‘permanently and totally disabled’ claims and applies a lower level of claim management, on the basis that there is little to be done with these, most serious, claims.

Every 3-5 years most insurers will have a review project to actively go through and re-certify each of these claims, to ensure nothing has ‘slipped through the cracks’.

The use of an automated questionnaire that would be sent to each claimant for completion could change the dynamic of these PTD units, and identify opportunities for resolution.

Using the Questionnaire tool the workflow can be automated to schedule the delivery of a claimant questionnaire at specified intervals, together with follow-ups and reminders as required. For example, an email request to complete a questionnaire could be sent to the claimant every 3-6 months, and a profile built up of scores, tracking that individual’s condition over time.

Over time, a response profile for that claimant would be established, and any improvement in condition or claimant motivation to return to work, could be highlighted to the claim manager for further investigation. This not only has the potentially of allowing claims managers to easily assess their PTD claims, but also allows claimants the opportunity to reflect on their own condition and flag changes.

Some individuals in the PTD block do recover enough to want to try to find employment, this tool will help you spot these claimants, and take further action.

If you have a large PTD block and would like to discuss this research, drop me an email at ibridgman@claimlab.org.