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 then…?
We’ve pinpointed the ideal range for our claims managers to be between 120 and 140 open claims at any given time. Within this range, our team can devote meticulous attention to every detail of each claim, and advocate effectively for our members with L&I. If your claims managers exceed this caseload, watch out for the problems listed above. If they consistently handle less, they might have room to tackle other vital workers’ compensation tasks. Offering fulfilling, manageable work for skilled claims managers benefits all—employers and employees—and results in better outcomes.
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.
