Why claims managers are scary

Transcription

1 Why claims managers are scary The impact of compensation systems on health after injury Nieke Elbers Arno Akkermans Keri Lockwood Ashley Craig Ian Cameron John Walsh Centre for Rehabilitation Research

2 Introduction Injured people Recovery Injured claimants Poorer recovery 0 Time Injured claimants have poorer recovery than injured pp who do not claim 2

3 Introduction Explanatory theories: Selection bias Group differences Secondary gain Financial incentive Secondary victimization Stressful compensation process 3

4 Introduction Stressful claim factors: - Claim duration - Legal dispute - Medical assessments (Cotti et al 2004) (Kilgour 2014, Murgatroyd, 2015) - Lawyer (Harris ea 2008, Dichraff 1993, Gun 2005) - Insurance company? Best predictor of increased anxiety (O Donnell et al, 2010, Grant et al 2014) Limitation: severely injured population 4

5 Introduction Stressful interaction with insurance company - Limited and impersonal communication - Problematic treatment approvals - Stigmatization - Negotiating settlement is gruelling - Power imbalance MORE RESEARCH IS NEEDED Limitation: sub-element of the studies Murgatroyd et al 2011 Lippel 2007 MacEachen et al

6 Introduction Research questions: 1. Is interaction with insurance company associated with anxiety? 2. What is stressful about interaction with insurance company? 6

7 Question 1 Is interaction with insurance company associated with anxiety? 7

8 Method Participants: 417 injured people who lodged claim after traffic crash Analysis: Multiple logistic regression Measurements: Predictor: Claims management (dis)satisfaction Outcome: Anxiety / Depressive mood (EQ5D) Independent factors: Demographic, Injury and Claim variables 2 months 12 months 24 months 8

9 Results Predictor: Claims management Dissatisfied Outcome: Anxiety / Depressive mood 100% 90% 80% 70% 65% 35% 60% 50% 40% 30% 37% 39% 29% 20% Satisfied 10% 0% 2 months 12 months 24 months 9

10 Results Independent variables Anxiety/depression Gender (female) Age Country of birth Education Socio-economic status Adjusted Odds Ratios (p <.05) 2 months 12 months 24 months 2.5 Work status Pre-injury health status (poor) Catastrophizing (high) Injury severity Type of injury (whiplash) Insurance company Dissatisfaction with insurance company = associated with anxiety Previous claim Lawyer engagement (not measured) Claim management dissatisfaction Claim settlement 1.9 R

11 Independent variables Gender (female) Age Country of birth Education Socio-economic status Work status Pre-injury health status (poor) Catastrophizing (high) Injury severity Type of injury (whiplash) Insurance company type Previous claim Lawyer engagement Claim management Claim settlement Discussion Anxiety/depression 2 months 12 months 24 months Claimant characteristics e.g. coping style seem to be important No difference between Xdifferent insurance companies (not measured) 1.9 Secondary gainx ? Lawyer Anxiety OR Anxiety Lawyer?

12 Discussion Limitations quantitative part: - Possible selection/attrition bias (education, age) - Self assessed one item outcome measure - Observational study, no causality 12

13 Question 2 What is stressful about interaction with insurance company? 13

14 Method Participants: Unsatisfied participants (n=152, n=113, n=94) Measurement: - Open question: What are you dissatisfied about? Qualitative analysis: - Grounded theory approach

15 Results Label Communication Compensation Medical Paperwork Liability Problem Claims managers difficult to get hold of, never returned calls Lack of information: what to do, how to claim, what was paid Reimbursements: not sufficient or delayed (e.g. loss of wages) Claim settlement: too slow or too fast Treatment approval: not approved or delayed Causality discussions (e.g. pre-existing problems, medical history) Same information multiple times; duplicated forms Too much; no assistance Discussions about circumstances accident Critical questions, e.g. by a private investigator

16 Discussion Recurrent issues Label Communication Problem Traffic or workers compensation literature Claims managers difficult to get hold of, never returned calls Lack of information: what to do, how to claim, what was paid Compensation Financial burden Medical Treatment approval: not approved or delayed Delays disability Interim payments Causality discussions (e.g. pre-injury problems, medical history) Paperwork Liability Reimbursements: not sufficient or delayed (e.g. loss of wages) Claim settlement: too slow or too fast New issues Same information multiple times; duplicated forms Better explanations Too much; no assistance Faster approval and prepayment for selected evidence based treatment Discussions about circumstances accident Critical questions, e.g. by a private investigator

17 Discussion Limitations qualitative part: - Qual research is difficult to generalise - Perceptions of people, not independently verifiable - Motor Accidents Authority: - Communication and treatment approval according to guidelines - Independent claims advisory service for assistance - Hybrid, mainly fault-based traffic injury compensation 17

18 Conclusion Two conclusions: 1. Pain catastrophising strongly associated with anxiety/depression Suggestion: assess level of catastrophising; provide social or professional support addressing helplessness, encouraging problem solving coping style 2. Dissatisfaction with insurance company associated with anxiety Suggestion: claim managers could become more proactive - Taking initiative in the interaction - Provide frequent updates about state of affairs - Smooth approval of treatment - Expedient reimbursement of costs - Adequate interim payments of established compensable loss of income 18

19 Conclusion Previous study: Proactive attitude claims managers facilitates return-to-usual-activities (Schaafsma et al, 2012) Beneficial injured people AND May imply cost reduction for insurers 19

20 Thank you Elbers, N.A., et al., Factors that challenge health for people involved in the compensation process following a motor vehicle crash: A longitudinal study. BMC Public Health, (339). 20