The Patient Experience in Perspective: Applying Empathy to the Work Comp Claims Process

Patient empathy has been a popular topic within the healthcare industry over the past two decades. As healthcare organizations began focusing on the patient ‘experience of care’ as a measure of success, demonstrating empathy became an important goal for individual healthcare professionals, as well as overall patient engagement programs.

In workers’ comp, there is increasing support for a more empathetic and patient-centric claims model, and with good reason. A poor claims experience is not simply a matter of dissatisfaction on the part of the injured worker. A strong correlation has been reported between the claims process experience and return to work status. According to one study, injured workers who had a negative or neutral claim experience were less likely to have returned to work than those who had a positive experience – 65% as compared to 84% – when controlling for all other factors.¹ In addition, negative interactions during the claims process can cause or exacerbate psychosocial factors, which can impact worker health in both the short and long term.²

The Workers’ Comp Patient Experience

Although the degree of injury or illness can vary, the majority of employees who file workers’ compensation claims require medical attention and, therefore, become patients. And their experience as patients may be inferior to those covered by other types of insurance. According to a recent study, workers’ comp patients are less satisfied with their medical providers than other payer patients (including private insurance, Medicare and Medicaid) with 59% of workers’ comp patients saying they would recommend their providers, as compared to 79% of non-workers’ comp patients.³ And a recent Healthesystems’ study found that 60% of patients who had initial medical exams reported a negative provider experience.⁴

But medical providers are not the only driver of unsatisfactory patient experience. A review of multiple qualitative studies regarding injured workers’ interactions with employers, insurers, and healthcare providers found that a majority of injured workers experience negative interactions at every stage of the claims process.² And approximately 70% of patients who were referred to specialists were satisfied with the care they received, but only 59% were satisfied with how that care was coordinated…⁵

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