In a bid to reduce claims durations and improve the sustainability of the life insurance industry, AIA Australia and TAL have voiced their support for rehabilitation and return to work services.
AIA Australia has released a set of ‘best practice principles’ for the provision of occupational rehabilitation. The principles were developed as part of an independent research project, commissioned by AIA Australia to help it adopt innovative approaches to claims management, in order to reduce pressure on claims costs and ultimately improve life insurance sustainability.
Conducted by injury management and rehabilitation expert, Petrina Casey, Director of Cortex Solutions, the research drew upon data collected from best practice studies from around the world, return to work data, rehabilitation practitioner and employer research, as well as qualitative insights from people who have experienced the rehabilitation and return to work process. The research followed the release of an initial insights paper, released by AIA Australia in August 2013 (see: Raise the Bar on Claims Management – AIA).
Ms Casey’s research identified the following six principles of rehabilitation best practice:
- Work is good for health and business – Understanding this philosophy will assist people to recover at work, encourage early claim notification and early intervention, and save employers money. Life insurers should aim to influence earlier notification of claims and/or encourage employers to act within the optimal time frame.
- Screening: part of a strategic claims management process – Having an operational model that has strong linkages between claims management activity and rehabilitation is essential. This involves clear protocols for referral to internal rehabilitation staff and for referral to external occupational rehabilitation providers.
- Claimants are supported and empowered – The evidence shows encouraging customers to resume normal activities, including work, to be effective in optimising return to work outcomes. Case managers that display empathy can strengthen the quality of the relationship with the claimant through the provision of support and guidance through the return to work process.
- Support the right intervention at the right time – Understanding the claimant’s circumstances and expectations with respect to their capacity to work following an injury or illness as soon as possible is important. This informs the appropriate intervention required and establishes a clear pathway for those coming back to work without specific intervention and those with risks requiring intervention.
- Communicate, collaborate and educate effectively – Collaboration with the return to work stakeholders (employer, doctor, healthcare providers, family, other) is important in setting and aligning expectations and achieving the best outcome.
- Focus on outcomes – For the individual life insured, appropriate outcome measures are captured and used to evaluate the effectiveness of the occupational rehabilitation services provided.
Ms Casey said that while life insurers might not have a strict obligation to help people get back to work, doing the right thing can be mutually beneficial.
“Life insurers can add value in helping people return to work with flexible rehabilitation services… Return to work should be a key outcome for all who have work incapacity and a measure of success for insurers regardless of the cause.”
AIA Australia said the principles can help ensure the right claimants are selected for the right treatment, getting them back to work sooner, as well as benefitting the fund and the employer.
“When implemented correctly, the benefits of employee rehabilitation aren’t just limited to the employee getting back to work and a full life faster. The results show that it can help to improve claims management right across the industry by reducing the duration of claims, providing greater benefits for members, as well as reducing the cost for life insurers, super funds and employers. It is a win-win-win situation,” said AIA Australia’s Acting Chief Executive Officer, Damien Mu.
“We know that getting occupational rehabilitation and early intervention right isn’t easy, but we think that life insurers have an obligation to policy holders to help people get back to work. We’ve been conducting extensive trials and have made significant improvements over the last two years to our occupational rehabilitation program and will be announcing more detail on this soon.”
…life insurers have an obligation to policy holders to help people get back to work
In related news, TAL has signed the Australasian Consensus Statement on the Health Benefits of Work, recognising the importance of work in helping people regain their health after an injury or illness.
The Statement was released in March 2011 by the Australasian Faculty of Occupational and Environmental Medicine of the Royal Australasian College of Physicians. The purpose of the Statement is to bring together a wide range of stakeholder signatories, who each affirm the importance of work as a determinant of health and commit to:
- Promoting awareness of the health benefits of work
- Offering support and encouragement to those attempting to access the health benefits of work
- Encouraging employers’ continuing support of workers’ occupational health
- Advocating for continuous improvement in public policy around work and health, in line with the principles articulated in the consensus statement
TAL Chief Customer Service and Operations Officer, Penny Coates, said: “TAL believes very strongly in supporting customers to return to health so they can get back on their feet and get on with their lives.
“Our own experience shows that when people return to work sooner rather than later that it promotes recovery and helps restore self-esteem and a sense of worth after being struck down by injury or illness.”
Swiss Re and AIA Australia are also signatories to the Statement.
I believe the big key to success is that the advisers are actively engaged in this process. They have the relationship and trust of the client. It is still very unfortunate but true, that claimants are scared of the insurance company not paying and tricking them out of their entitlements and it is the adviser who brings that reassurance back to the client. there is no doubt that my clients get a better result with the active involvement of our advisers.
I believe to make this there is a need to bring the advisers in to train them on the operation of these principals and make sure they are advocates to the whole process. I am very passionate about claims management and want the best for my clients and there is no doubt the longer they stay on claim the harder it for them to resume their pre disability lives.
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