Managing claims effectively, whether internally or through a TPA, requires a manageable workload for claims managers. Is your claims manager dealing with too many cases? Understanding how overwhelming caseloads can affect claims handling is essential, impacting outcomes and costs.
Let’s review some of the top problems with claims overload:
- Claims fail to receive enough attention and take longer to close:
Less direct attention and focus from claims managers impacts their ability to process claims efficiently and effectively. As we all know in the world of claims, immediacy is key; every day counts and costs. - Shortcuts are taken, compromising quality:
Shortcuts or treating claims like transactions to expedite the process can occur. This can compromise the quality of claim handling, leading to errors, oversights, and inadequate resolutions. - Strategic planning time is scarce:
Strategic discussions on kept-on-salary, return-to-work and light duty are sidelined amid heavy workloads, potentially neglecting proactive measures. The importance of early return-to-work and kept-on-salary programs has been underscored by the adoption of two recent bills in Washington. - Details may be overlooked, risking accuracy: Claims managers may be prevented from thoroughly investigating claims accuracy or other considerations such as occupational disease, or PPD. This increases the likelihood of errors, and missed opportunities, further complicating the claims process.
- Burnout becomes a real concern, leading to turnover: If your claim requires contestation, will your claims manager have the mental bandwidth and energy to advocate for you?
High claims volume can lead to claim manager burnout and dissatisfaction, causing turnover that not only disrupts continuity and service quality but also increases costs for employers.
What do these all have in common? They can all drive up workers’ compensation costs, not to mention creating frustration and dissatisfaction.
What is an ideal claim load?
An optimal workload for our claims managers allows them to give meticulous attention to every detail of each claim and advocate effectively for our members with L&I. When caseloads get too high, the risks outlined above can start to appear. Conversely, if managers consistently handle fewer claims, they may have capacity to focus on other essential workers’ compensation tasks. Striking the right balance benefits everyone—employers, employees, and the claims team—and leads to better outcomes overall.
How do we help Washington manufacturing and agriculture employers with effective claims management? We’d love to talk with you about it. Learn more here or contact us.
