2014 Workers Compensation Claims Operational Benchmarking Study

Executives, claims professionals, and others serving captives providing workers compensation coverage should read the results of the 2014 Workers' Compensation Benchmarking Study—Claims Management Operational Study. The study had the benefit of the participation of more than 400 managers, directors, and executive-level claims leaders, a 57 percent increase from the prior year.

The study was guided by an advisory council of independent experts and an independent principal researcher. Rising Medical Solutions, a medical cost containment and care management company, led the project management, industry outreach, and publication of the study.

Numerous findings in the report include the following.

• Less than 50 percent of claims organizations have training and development programs, and even less invest in training new hires.
• Less than 50 percent of organizations are using advanced analytics to identify high-risk claims or workflow automation.
• Medical costs average 60 percent of overall claims costs—even so, measuring medical management provider outcomes is rare, with less than 29 percent using risk/reward strategies with medical providers.

The survey also provides detailed, useful information on the average caseload for lost-time claims examiners, claims closure ratios (number of claims closed divided by the number of claims received during the same period), and the percentage of claims inventories that have been open for more than 5 years.

The 2014 study reflects an industry facing critical hurdles. Based on 70-plus data points, the results further quantify how claims organizations focus resources to address these substantial hurdles. Key findings reveal the following.

• Challenges measuring best practices within top-ranked core competencies
• Declining investment in current and future talent development
• Low adoption of disruptive technologies, such as predictive analytics and workflow software
• Continued obstacles with claims system integrations
• Limited use of outcome measures and risk/reward strategies to propel top performance from internal staff, vendor partners, and medical providers
• Observed impact of the Affordable Care Act on claims

"With so many priorities and complex industry requirements, how do claims leaders identify the initiatives that will generate the greatest ROI and drive the most value," asks principal study researcher, Denise Zoe Algire, director of Managed Care & Disability, Corporate Risk Management, for Safeway, Inc.

"Every day we see the competing demands placed on claims organizations. Together, with the industry's considerable involvement, we're building benchmark data to support these organizations as they make strategic resource allocation decisions in a tough environment," according to Jason Beans, CEO of Rising Medical Solutions, the founder and publisher of the study.

Request a copy of the 2014 Workers' Compensation Benchmarking Study—Claims Management Operational Study from Rising Medical Solutions.