A new approach to managing complex disability claims

Managing an increase in disability claim complexity and duration.

The degree of complexity within each disability claim has always varied, with some presenting as straight-forward that end with a return to work, while others exhibit a level of subjectivity that require a rigorous approach to uncover otherwise obscure factors that may be preventing a return to work. 

These factors, sometime referred to as “non-medical drivers,” can be responsible for longer claim durations and fewer successful return to work outcomes.

Understanding non-medical drivers

Issues of claimant motivation, perceptions of functional loss, perceived barriers to returning to work, and possible secondary gain can have far more impact on our ability to facilitate successful outcomes than the more obvious clinical issues. Given the emergence of a mental health crisis from COVID-19, the need for a holistic claim management approach that can uncover those issues early within the life of a claim has never been greater.

The emerging mental health crisis

Few will argue that the impact of COVID-19 over the past nine months has resulted in a mental health crisis within our society. In Mental Health America’s recent report, “COVID-19 and Mental Health: A Growing Crisis,” the findings were sobering. A few of the headlines included the following:

From January to September 2020, there was a 93 percent increase over the 2019 total number of anxiety screens and a 62 percent increase over the 2019 total number of depression screens.

Managing this crisis

In the past, there were certain elements of a claim management model that were required to effectively manage complex claims, including:

While we are just starting to see how and to what extent the mental health crisis will manifest, one thing is certain: innovative and creative approaches to claim management will be rewarded.

Notably, tools like a psychometric claimant questionnaire are proving to be an effective way of uncovering non-medical drivers. The results of these questionnaires identify key issues a behavioral health clinician or claim analyst can explore more deeply when conducting a detailed claimant outreach. Leveraging the perspective gained from this process early within the claim can result in an improved understanding of a whole-person function and the identification of real and perceived barriers to the claimant’s successful return to work.

How PDA can help

PDA is dedicated to finding creative solutions to support carriers during what many expect to be an increase in claim incidence and complexity. We have created innovative offerings that leverage the use of psychometric questionnaires, including our new Behavior Health Case Management solution.

Our team of seasoned claim professionals is prepared to support your organization in effectively managing complex claims. Contact PDA to discuss how we can provide this innovative support to your claim organization.

Mark Sawyer, CLU
Vice President, Claim Performance Solutions
Professional Disability Associates
(207)747-4308 | msawyer@pdamaine.com