Understanding the market and maintaining a competitive edge isimperative in the ever-evolving Workers’ Compensation industry.

To ensure we are always up to speed on the latest industrydevelopments, I continually search for new innovations within theindustry.

While attending a conference a number of years ago, I firstlearned about pre-claim nurse triage as an effective tool to getinjured workers the care they need while also reducing unnecessaryclaims.

(Pre-claim nurse triage is a service that provides employers andtheir injured workers 24/7 access to registered nurses by phone,who recommend the most appropriate care for the individual.)

This was followed by one of our agents raising the valueproposition of pre-claim nurse triage and what it could mean forour Workers’ Comp policyholders. With some additional research, itwas becoming clear pre-claim nurse triage should be part of ourcompany’s Workers’ Comp portfolio.

Prior to incorporating triage, we believed the number ofWorkers’ Comp claims we were handling and the amount we werespending on claims was average. Since implementing pre-claim nursetriage, we found we could lower our comp spend dramatically —saving us millions, while providing better care to the injuredworkers.

As we searched for a pre-claim nurse triage provider, thesefactors were important:

• Transparency. There are many different modelsof pre-claim nurse triage and most were not for us. While doing ourresearch on triage providers, we heard from vendors that benefitfrom the increased number of claims they refer. We wanted a partnerthat did not have any conflict of interest, such as revenueincentives resulting from opened claims.
• Reliability and efficiency. Like any business,reliability and efficiency are vital keys to success. A pre-claimnurse triage provider needs to be available to injured workers24/7, 365 days a year in order to provide first-aid screening andthe right care when needed. With a proven method of consistentevidence-based medical assessments, it was essential ourpolicyholders and their injured workers have access to immediate,accurate recommendations for treatment.
• Success evaluation. It was and continues to beimperative to have the ability to evaluate success and measure theimpact of our pre-claim nurse triage program. We wanted a providerthat could help us evaluate success based on the quality carerecommendations we provide to injured workers, while reducing ourWorkers’ Comp spend and limiting our exposure to fraudattempts.

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(Photo: Thinkstock)

Transitioning to pre-claim nurse triage

In 2011, we began our partnership with McHenry, Ill.-basedhealth services provider Medcor toimplement pre-claim nurse triage into Secura’s offerings. When we first implemented the triage program, which webranded Nurse Hotline, we didn’t know how our policyholders wouldadapt to such an innovative first-aid screening process. Ourinitial goal was to have 50% of claims for identified Workers’ Compaccounts come through pre-claim nurse triage. To our amazement, wequickly exceeded 50% and were pushing approximately 75% of our compclaims coming through triage within nine months of implementingNurse Hotline.

As a result of the immediate success, we expanded our servicewith Medcor to provide triage for larger accounts, and the resultscontinued to surpass our expectations. As the numbers increased inthe manner in which Medcor had originally outlined, so did ourfaith in pre-claim nurse triage. This is our preferred method forclaim reporting for our accounts.

As early adopters of the system, we’ve seen a number of valuablebenefits from transitioning to pre-claim nurse triage, includinglower lag time, improved loss-ratios, lowerincurred-but-not-reported claims, and increased policyholdersatisfaction.

In addition to the clear financial benefits, working inpartnership with Medcor continues to provide better treatmentdecisions for injured workers, while lowering our costs andreducing the pressure many policyholders experience when anemployee is injured.

Tony Brecunier is the director of Workers’ Compensation atAppleton, Wis.-based Secura Insurance Co. He is a CharteredProperty Casualty Underwriter, has an Associate in Claims, and hasmore than 15 years of experience in the Workers’ Comp industry. Hecan be reached at [email protected].

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