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Long Duration Claims

Long Duration Claims. (Occupational Health Society of Australia (WA Branch). Craig Stewart State Claims Manager Workers Compensation Claims WA. Agenda. Costs Aligned to Duration Causative Factors What Can Employer’s Do What Are Insurers Doing. Cost Increase Aligned to Duration.

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Long Duration Claims

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  1. Long Duration Claims (Occupational Health Society of Australia (WA Branch) Craig Stewart State Claims Manager Workers Compensation Claims WA

  2. Agenda • Costs Aligned to Duration • Causative Factors • What Can Employer’s Do • What Are Insurers Doing

  3. Cost Increase Aligned to Duration CGU Insurance Limited 2013 Not to be reproduced or copied without express consent from CGU Insurance Limited

  4. Causative Factors for Longer Duration – New Lodgements • Employer Self Managing • Delay in lodgement • Pending liability • Disputed Liability CGU Insurance Limited 2013 Not to be reproduced or copied without express consent from CGU Insurance Limited

  5. Causative Factors for Longer Duration - Flags/Barriers • Pain Feature Related • Occupational • Psychological • Emotional • Social • Lifestyle • Physical • Other CGU Insurance Limited 2013 Not to be reproduced or copied without express consent from CGU Insurance Limited

  6. Causative Factors for Longer Duration - RTW • Employer based RTW with no set time frames • RTWP not focused to achieve an outcome • Knowing when to appoint an external provider • Interstate workers • Principally controlled worksites • Visa workers CGU Insurance Limited 2013 Not to be reproduced or copied without express consent from CGU Insurance Limited

  7. What Can An Employer Do • Pre-employment medicals aligned to the role • Set up preferred providers • Liability, provide factual information, not hearsay • Manage by the Act not emotionally CGU Insurance Limited 2013 Not to be reproduced or copied without express consent from CGU Insurance Limited

  8. What Can An Employer Do • If you are managing internally set a $ limit • Learn how to identify flags and manage them • Make key decisions around RTW at the right time CGU Insurance Limited 2013 Not to be reproduced or copied without express consent from CGU Insurance Limited

  9. What Are Insurers Doing • Liability • Triaging • Set clear action plans • Utilise appropriate resources • Case Conferences with GP’s • IME reviews CGU Insurance Limited 2013 Not to be reproduced or copied without express consent from CGU Insurance Limited

  10. What Are Insurers Doing • Settlement strategies • Does surveillance work • Communication • Work with and educate employers CGU Insurance Limited 2013 Not to be reproduced or copied without express consent from CGU Insurance Limited

  11. Questions

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