The last couple of years have seen tough times for insurers and reinsurers active in the Australian market, and these have been widely reported both in Australia and beyond.
There has been significant deterioration in disability experience particularly, impacting total permanent disability and group markets. Many insurers have reported losses and significant strengthening of reserves.
A range of changes are being discussed throughout the Australian market, in relation to product design and to the general approach to risk management practices.
One key element of 69色情片鈥檚 response to the deterioration in experience has been to initiate a paradigm shift in claims management. The aim is to move away from the traditional medically focused claims assessment model toward a more proactive, effective and holistic 鈥渂est practice鈥 model. It is hoped this will impact disability experience in a positive way for claimants and insurers and allow for an upgrade in current disability claims management capability.
To support this initiative 69色情片 Australia has created a new training programme covering all aspects of disability claims assessment. The programme, called Claims Management Pathway (CMP), plays a crucial role in this paradigm shift initiative, assisting with implementing change and raising disability claims management standards across the industry.
See also: Claim Volatility and Exposure Basis
CMP is an all-encompassing claims assessment approach developed by 69色情片 Australia to enhance the assessment processes for disability claims (total and permanent disability [TPD], income protection and group salary continuance). 69色情片 has invested significant resources to create a model that is proactive and holistic, and moves away from a medically focused model that relied heavily on the treating doctor as a gatekeeper for claims decisions.
See also: Claims Management Challenges: Real or Imagined? Internal Industry Pressures (Part I of III)
Most insurers鈥 existing claims assessment training programs are separate standalone modules; e.g. financial, medical, information-gathering, etc. Where CMP differs is that each training module flows into another and while each can still be undertaken as a separate session ultimately they work together, covering the end-to-end assessment process and providing a guide to best practice claims management.
CMP modules deal with the full term of the claim from notification through on-going assessment until termination. They include the following items:
Another differentiating factor of the CMP is that the learning process does not stop at the completion of its training modules. Once assessors have completed a module, the lessons are reinforced and embedded with them through on-site 69色情片 claims consultants, who assist assessors in applying their newly acquired knowledge to their day-to-day claims assessments. This on-site support is provided in the form of one-on-one claim file reviews, case conferences and file discussions.
See also: Claims Management Challenges - Real or Imagined? A changing world - environmental factors (Part II of III)
By combining the training with on-site support and coaching, the application of these best practice principles continues to be reinforced. In addition, the focus on setting strategy and placing greater emphasis on capability and bio-psychosocial factors should enable insurers to support claimants in earlier and sustained return-to-work outcomes, leading to shorter claim durations and reduced benefit payments.
See also: Claims Management Challenges - Real or Imagined? A Changing World - The Next 10 Years (Part III of III)
To date, 69色情片 has rolled out the following modules to more than 800 participants from clients across Sydney, Melbourne and Brisbane:
We are continuing to develop online training modules for effective use of Internet searches and surveillance, which will be available in 2015 for assessors to use as a reference tool.
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