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Closures of pandemics adversely affect the development of comp claims



Pandemic-related suspensions in early 2020 had far-reaching consequences for the workers' compensation system, with delayed medical interventions that halted claims and redundancies and furlougher that eliminated return to work in some industries, experts say.

While the re-opening of medical clinics and the rapid adoption of telemedicine have helped get most of the compensation claims back on track. A second wave of shutdowns affecting large parts of the country is likely to create more problems in the coming months, they say. This year, delays in non-emergency and optional surgeries in the U.S. health care system could lead to as much as 45 weeks of surgical delay, according to a report released in November by King of Prussia, Pennsylvania-based MedRisk LLC.

This trend may continue and negatively affect workers' compensation as COVID-1

9 cases nail down and force state closures, said the managed care organization. Delays in physiotherapy, for example in claims for soft tissue injury, can lead to higher medical costs and reimbursement costs than similar claims without delays in treatment, says MedRisk in its report.

"Obviously, when the pandemic first hit, there were many delays (in work compensation)," said Dennis Tierney, Norwalk, Connecticut-based National Head of Work Compensation Claims for Marsh LLC. "It was a huge challenge for the industry – probably one we have never seen before. All the things needed to help move claims just didn't work. "

" During the second quarter, when things really turned off when it came to medical treatment, we definitely had workers who experienced delays and cancellations. in their ability to go through treatment, ”said Kathy Gehring, vice president of nonprofit State Accident Insurance Fund in Oregon, known as SAIF, in Salem, Oregon.

New workers' compensation claims and those with non-critical operations were the most affected by the COVID-19 restrictions, says Max Koonce, Fayetteville, Arkansas-based executive at Sedgwick Claim Management Services Inc.

"It was not just that the fact that (surgeries) were postponed for six weeks, "he said." Then we had to try to reprogram them again. … It was very disturbing for these individuals, and during the leave you continue to pay disability benefits. "

Extensive telemedicine helped Sedgwick ensure that workers who had to delay operations were ready when they were relocated, said Mr. Koonce, who noted that TPA applicants' use of telemedicine increased by 1000% since the pandemic began.

"With older claims it really helped them keep that pace, "he said.

CorVel Corp., which had already handled claims via telemedicine, took the same approach and applicants have since embraced the opportunity t ill virtual care, says Michele Tucker, Sacramento, California-based vice president of business at CorVel.

"We had to restructure and relocate (to telemedicine) those patients where their brick suppliers were no longer available or elective surgeries were delayed so that we could ensure continuity of care," she says.

The rapid transition to telemedicine and Virtual hearings helped Ohio avoid many common delays, says Meghan Delaney, an advisor at Fisher Phillips LLP's offices in Cleveland and Columbus, Ohio.

"When it comes to resolving claims, we have been very successful in beating "We have been able to aggressively follow some of these settlements … and employers were looking at opportunities to close some problem claims."

Mr Tierney at Marsh also focused on early claims and used data analysis to identify claims that under normal circumstances may seem premature to close but that by 2020 may be ripe for settlement.

"Obviously, if you have injured workers on the tail of their career or close to reaching the point of (maximum medical improvement), there is more of a tendency to want to settle much earlier, he says.And the rate of closure increased early in the pandemic, although they have since leveled out, said

Returning to work in the COVID-19 economy has also made the resolution more demanding "in favor of injured workers, as well as the benefit of our customers," said Koonce.

"We did an analysis early to see what each state said with respect to continued disability benefits. "Basically, you continue these benefits if there is no job for them to return to," he said. "At that time, you look at how you can resolve these claims, how you can get them to maximum medical improvement."

More insurance and workers' compensation news about the coronavirus crisis here ].


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