June 5, 2021

Empowering the Patient as a Mitigator of Claims Complexity

Managing the complexities of claims is more important than ever – but as we continue to peel back the layers of what drives the duration, cost, and patient safety concerns associated with complex claims,1 in some ways it is becoming more challenging than ever. And as we as an industry continually develop new and innovative tools to help address these challenges, there is one asset that can perhaps be leveraged more optimally as a mitigator of claim complexity – the injured worker patient.

Even as workers’ compensation programs have been moving towards a more patient-centric approach to managed care, injured worker patients themselves may not always be positioned as equal stakeholders. To some extent, they move through the claims process as the object in Newton’s third law of motion, upon which the forces of the system, however well-designed or intentioned, are applied.


The challenge with this? Patients as a stakeholder hold the greatest individual level of influence over the outcomes of their care – for better, or for worse. In the instance of catastrophic injuries, this may also include supporting family members or partners who may be assisting with caretaking. Specific to more complex claims, this influence is typically seen to worsen complexities. In a research study conducted by Healthesystems, two-thirds of workers’ compensation professionals felt that the injured worker often does not play enough of a role in mitigating complexities, but rather, contributes to them.1

This may lend some insight into why aspects of the claims process may involve the injured worker in a unidirectional fashion, delivering information without a structure or process in place that invites patient input.

But what if more aspects of the claims process were built to better accommodate the flow of information in both directions? Consider one example where the injured worker is involved in their claims journey from a bidirectional standpoint in their own claims experience – the initial reporting of an injury.

Continue reading the article in full at RxInformer.

Workers’ Comprehensive

News and views in workers’ comp

Important news in workers’ comp delivered to your inbox