Captive Insurance Industry Has Source for Workers Compensation Benchmarking Information

Results of the fourth annual Workers’ Compensation Benchmarking Study, a claims management operational study recently released by national medical cost containment and care management company Rising Medical Solutions show how good claims outcomes were ranked in terms of importance by the study respondents, and four key operational differentiators of higher-performing claims organizations were identified.

The 2016 study goal was to determine which claims management "best practices" are actually validated by claims data. The study conclusions are based on a survey of 492 claims leaders, including third-party administrators, insurers, employers, risk pools, and governmental entities.

Good claims outcomes ranked in terms of importance, based on the opinions of survey participants, are as follows.

1. Employee return to the same or better pre-injury functional capabilities
2. Return-to-work at or below industry benchmarks
3. Claims closure/resolution at or below expected average benchmark
4. Maximum medical improvement achieved at or below evidence-based medicine guidelines expectations
5. Lack of litigation

Selected results of the study also include the following.

• Organizations with lost time caseloads of 125 or less had more favorable claims closure ratios.
• Twenty percent of the survey respondents had a high percentage of their claims inventory that was open more than five years.
• Fifty-one percent of the survey respondents indicated their organizations linked their claims outcomes to key claims performance measures.

Four key operational differentiators of higher-performing claims organizations were identified as a result of the study.

1. Using key performance benchmarks to show how desired claim outcomes are achieved or not achieved
2. Use of claims decision support tools
3. Utilizing an employee-centric claims service model
4. Being more engaged in new initiatives such as value-based care, linking provider quality and outcome measures to provider agreements, and employing formal knowledge transfer strategies

Captive insurance company claims managers, service providers, and executives are encouraged to read the study and its useful benchmarking information. Request a copy of the 2016 Workers' Compensation Benchmarking Study, authored by Denise Zoe Algire.