The Meaning of Claims Advocacy, Implemented in House or Outsourced

What does Claims Advocacy mean to you? If you ask ten people what claims advocacy means, you will receive ten different responses.

Claims Advocacy creates an environment that allows the claimant to feel heard. Addressing the needs and concerns of the injured worker builds and nurtures trust from the very beginning of a claim. This level of customer service prevents the common breakdown in communication between the claimant and carrier, stops litigation prior to the start and ultimately leads to a faster return to work for the claimant when possible with a more cost effective resolution. This all results in drastically reduced administrative costs. An outsourced advocate who understands the full picture from all sides, can connect with the claimant as long as they have had the experience of navigating their own workers’ compensation claim to truly understanding what the claimant is going through.

The human element factor goes a long way with a claimant when true trust is created. Here our outsourced past claimant to new claimant model shines the most, when a communication breakdown occurs as the claimant knows to ask their adjuster/ case manager to speak with their advocate. This is repeatedly instilled from the beginning of the claim and during each discussion feedback session with the claimant every three weeks stopping the carrier from being the catalyst for litigation to begin when calling a claimant non-compliant and defiant leaving no choice but to proceed to litigation by the claimant. The situation is defused when the data and stat reports obtained directly from the claimant with options for resolutions is utilized in real time (emailed within hours of the completed call back to the adjuster/ case manager) as the claimant is happy to share everything with someone who has walked in their shoes and been in the very same place prior. A past claimant viewed as a true advocate, being outsourced from the carrier/ employer with a voice to speak up on behalf of the claimant to the carrier addressing alternatives for any situation which arises, keeps the claimant compliant within the system by reducing administrative and total cost of risk for each claim.

The advocacy model is that there is no one size fits all standard approach. An advocacy service must be custom tailored to your company’s specific needs, as each claim is unique. This makes it difficult for untrained in-house claims managers to implement. Claim managers and adjusters may try to empathize with the claimant, often in spite of their training, claims sustainable trust based connection is highly unlikely. The claimant’s life has been substantially uprooted, which may make them eager to seek out such guidance for litigation as any trust that develops here is short-lived when being implemented in house.

A qualified advocate will solidify the trust in a new claimant relationship within the first 30 days of injury or less, though may not be completed in house to be truly successful as the claimant views an in house advocate as just an extension of the case manager or adjuster. Utilizing an outside advocacy service with a previous claimant to new claimant model creates a unique bond that can’t be matched in house or by any other service. No one can understand what a current claimant is going through, unless they have been in their shoes. The trust factor that develops here is one that no adjuster, advocate, or counsel can emulate, unless they have had direct experience navigating their own workers’ compensation claim unless trained specifically for the utilization of this model.

Written by:

Paul Gold

Founder & CEO

PG Resolutions Group

Tel: 1-800-473-4450