Workers’ compensation is an extremely complex form of social insurance. Those who specialize in workers’ compensation tend to adopt jargon as a kind of shorthand to express concepts to those in the know. I’m sure you have heard (maybe even said), “I have this back claim…” when what is really meant is, “I am assisting a person with a work-related injury to the back…”. Unfortunately, this use of jargon can have unintended and negative consequences.
Recently, I have read blog posts and heard speakers at conferences referring to “old dog” claims. I have heard many explanations for the source of this idiom. One commentator said the term arose from the dog-eared corners of the large paper files that are the inevitable consequence of serious injuries and long-term claims management. Another suggested the term related to those serious and long-term claims that “hound” adjudicators and frustrate administrators due to their lack of resolution. Regardless its origin, those unfamiliar with the term may interpret “old dog” claims as somehow disparaging the people who made them. Worse yet, the internal use of a term with such a negative connotation may influence the way we think about or act on some claims.
A related term, “long-tail” claims can create barriers between workers’ compensation insurers and those the system intends to help. The “long tail” in workers’ compensation refers to the statistical property of the distribution of claims, particularly as it relates to duration. The vast majority of claims are very short duration but a few go on much longer and a very few go on with some benefits that may last a lifetime. It is impossible to know just how long a particular claim for a particular injury might require active claims management, adjudication of medical costs, and payment of benefits. Insurers use actuarial estimates based on experience to quantify the costs. Claims at the far end of the claim duration distribution—the “long tail” of a graphical depiction—will generally have the greatest costs.
Most of us are not actuaries or statisticians. Those of us who endured rather than enjoyed the statistics courses in our academic careers can probably still recognize the statistical aspect of the “long tail” and recall vaguely the problems of asymtopical distributions, skewing, and corrections for right-hand truncation. For those without statistical knowledge, the term “long tail” has a somewhat negative connotation, an implied variance from some level of “normal” or “typical”. To those individuals, the use of the term may create a barrier or put them on the defensive with the insurer, adjudicator, case manager or other workers’ compensation personnel. It is not hard to imagine people worrying that adjudicators in WC would be actively working to terminate claims in the interests of shortening that long tail—not a recipe for a trusting relationship.
A 2010 survey had good news and bad news for insurers regarding trust. The headline read “Trust in Canadian insurance industry jumps 17%”. The article revealed this significant increase was on a base of only 38%. At 51% of opinion leaders trusting insurers, this improved standing is still well down the in the ranking behind other sectors like health care and technology. Given this significant lack of trust in insurers, it is time we stopped using terms that have such negative connotations even in internal discussions.
I believe workers’ compensation professionals in state funds, private carriers, TPAs and related agencies are sincerely working in the best interests of those WC was created to serve. Abandoning jargon and shorthand terms like “old dog” and “long tail” claims may seem like a small thing but words matter. Words create perceptions and perceptions create reality.
Showing posts with label workers' compensation measures. Show all posts
Showing posts with label workers' compensation measures. Show all posts
Monday, July 16, 2012
Monday, January 11, 2010
How do you measuer return to work success?
Over the weekend, I received an email from Australia seeking information regarding return to work (RTW) programs and outcomes in North America. One question asked was regarding the percentage of injured workers who RTW. One might think there was a simple, common measure that would allow direct comparison across all workers’ compensation jurisdictions. In reality, however, there are few jurisdiction using the same method to measure RTW success.
The vast majority of injured workers who file workers’ compensation claims in BC and elsewhere experience a successful RTW. What percentage and how durable a return depend on the population being studied, the denominator uses and how RTW is defined. It also depends on the law and economy in the jurisdiction under study.
Many jurisdictions suggest they achieve 85-90% RTW for time-loss injuries. Most injured workers RTW with their accident employers anyway so the high percentage may not indicate anything about the effectiveness of the law, policy or program in a particular jurisdiction.
The 2008/09 Australia & New Zealand Return to Work Monitor examines these questions in detail. Using a common survey methodology that samples from the population of claims with “10 days or more compensation (including any excess) paid”, the reported statistics are among the most comparable around. The ‘employer excess’ refers to an employer deductible where the employer is responsible for paying wage loss benefits and medical costs up to certain limits. This is a common, (although not standardized) provision in Australia. Most jurisdictions in this study have legislation that requires the accident employer to return an injured worker to employment.
The Monitor reports on both ‘durable’ and ‘non-durable’ RTW. The results are summarized in that report as follows:
More commonly, a report on RTW will be designed to meet the needs and data of a single jurisdiction. For example, a report out of the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group in November 2008 reported on ‘initial’ RTW rates. The research found 74% -78% of claims (injury year 2004-06) had an initial RTW within two quarters post injury. This climbed to around 83%-88% by four quarters and topped out at 90-93% by 12 quarters (the longest category studied). These results have to be taken in the context of the unique Texan workers’ compensation context. For a variety of reasons, it is likely the study population in Texas is more severely injured than in the Australian & New Zealand Monitor’s data.
There is no standard for measuring RTW in Canada. Many jurisdictions in Canada have mandatory reinstatement laws that require an employer to return an injured worker to employment (although BC does not have such a provision). All have some form of RTW program.
New Brunswick 2008 Report to Stakeholders states:
At WorkSafeBC, RTW is not just another program; it is an integral part of our strategy and linked directly to the goal of improving satisfaction, accessibility and public confidence. While most workers return to their accident employer, the focus of BC’s vocational rehabilitation efforts is on those who face significant barriers in achieving a successful RTW.
A key indicator of RTW success for WorkSafeBC is the percentage of cases referred to Vocational Rehabilitation assistance who achieve a successful outcome. Measured as a percentage of all closed cases, the results have been as high as 81.7% in 2008. Although the current economic conditions in the province are likely to result in a lower level, the importance of RTW will not diminish.
We know from research that work is good for health and well-being. Regardless of how an agency decides to measure RTW, supporting every injured worker to achieve a safe and durable RTW is and should continue to be a priority for every workers’ compensation system.
The vast majority of injured workers who file workers’ compensation claims in BC and elsewhere experience a successful RTW. What percentage and how durable a return depend on the population being studied, the denominator uses and how RTW is defined. It also depends on the law and economy in the jurisdiction under study.
Many jurisdictions suggest they achieve 85-90% RTW for time-loss injuries. Most injured workers RTW with their accident employers anyway so the high percentage may not indicate anything about the effectiveness of the law, policy or program in a particular jurisdiction.
The 2008/09 Australia & New Zealand Return to Work Monitor examines these questions in detail. Using a common survey methodology that samples from the population of claims with “10 days or more compensation (including any excess) paid”, the reported statistics are among the most comparable around. The ‘employer excess’ refers to an employer deductible where the employer is responsible for paying wage loss benefits and medical costs up to certain limits. This is a common, (although not standardized) provision in Australia. Most jurisdictions in this study have legislation that requires the accident employer to return an injured worker to employment.
The Monitor reports on both ‘durable’ and ‘non-durable’ RTW. The results are summarized in that report as follows:
The RTW rate showed steady improvement between 2002/03 (83%) and 2005/06 (87%) returning to pre 2000 levels (mid 80%). There has been no further improvement, with the 2008/09 national RTW rate similar to all previous years (83%). The durable RTW rate has gradually declined over the last four years, with a lower durable RTW rate being recorded in 2008/09 (72%) to 2007/08 (75%).
More commonly, a report on RTW will be designed to meet the needs and data of a single jurisdiction. For example, a report out of the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group in November 2008 reported on ‘initial’ RTW rates. The research found 74% -78% of claims (injury year 2004-06) had an initial RTW within two quarters post injury. This climbed to around 83%-88% by four quarters and topped out at 90-93% by 12 quarters (the longest category studied). These results have to be taken in the context of the unique Texan workers’ compensation context. For a variety of reasons, it is likely the study population in Texas is more severely injured than in the Australian & New Zealand Monitor’s data.
There is no standard for measuring RTW in Canada. Many jurisdictions in Canada have mandatory reinstatement laws that require an employer to return an injured worker to employment (although BC does not have such a provision). All have some form of RTW program.
New Brunswick 2008 Report to Stakeholders states:
Ninety-six percent of injured workers who lost time from work returned to employment or their pre-employment status following their injury. Two percent were not employed immediately following their claim closure, and 2% were fully disabled and incapable of employment.
At WorkSafeBC, RTW is not just another program; it is an integral part of our strategy and linked directly to the goal of improving satisfaction, accessibility and public confidence. While most workers return to their accident employer, the focus of BC’s vocational rehabilitation efforts is on those who face significant barriers in achieving a successful RTW.
A key indicator of RTW success for WorkSafeBC is the percentage of cases referred to Vocational Rehabilitation assistance who achieve a successful outcome. Measured as a percentage of all closed cases, the results have been as high as 81.7% in 2008. Although the current economic conditions in the province are likely to result in a lower level, the importance of RTW will not diminish.
We know from research that work is good for health and well-being. Regardless of how an agency decides to measure RTW, supporting every injured worker to achieve a safe and durable RTW is and should continue to be a priority for every workers’ compensation system.
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