Trends Emerge as Claims Industry Responds to Virus

The COVID-19 pandemic is having an unprecedented effect on conducting business in the United States and globally. Office buildings have been traded for home offices and make-shift desks. Meetings in conference rooms have been replaced with video conferences. Business travel has all but been grounded completely. High-end restaurants are serving curbside to-go meals. And finally, happy hours at the local bar have been swapped for virtual happy hours via webcams.

The claims industry has also had to change overnight. Formal hearings, in-person mediations and in-person conferences have been cancelled or postponed indefinitely. Judges’ decisions will be delayed in many cases. Injured workers who are under quarantine may be unable to visit their medical provider or deposit their check in the bank. Some companies deemed “non-essential” may no longer be able to provide modified work for injured workers. In many ways, the industry was prepared for this obstacle, but there is always room for growth – and situations like this can spur that growth.

The claims industry was well-prepared for the process changes required by the pandemic, thanks to three things.

1. Direct Deposit. Injured workers have long been able to have their wages or other compensation directly deposited into their bank account, rather than receiving a paper check in the mail. This system will be relied on heavily as quarantine, travel and business restrictions, and possible delays in the mail make routine banking difficult or impossible for some. Direct deposit offers advantages for both the payor and payee. Direct deposits can be quicker and more efficient than paper checks and they can no longer be “lost in the mail”.
2. Electronic Filing/Correspondence. Many workers’ compensation venues offer electronic filing of forms and other case-specific mail. The Department of Labor (DOL) has been accepting documents electronically via the SEAPortal for several years. Additionally, some employers and carriers (including ALMA) have set up a direct digital transfer of documents with the DOL. ALMA injury reports and medical records are automatically sent to the DOL daily using FTP. As a result, the claims industry is relying less on physical mail and shipping packages than it once did, and certainly less than other industries.
3. Telework. While working from home is not without precedent in claims, companies (including AEU) have increased their remote employee counts from a handful of claims to 100% of the staff. All claims material is kept in the cloud, so files can be accessed wherever there is a secure internet connection and there is no need for a paper file. As previously mentioned, filings and other correspondence can be submitted digitally. In addition, claims adjusters routinely communicate with attorneys, medical providers and injured workers through email.

We’re also seeing a couple of trends emerging during this pandemic – and they may have staying power.

1. Telemedicine/Telehealth. According to the American Academy of Family Physicians, telehealth refers broadly to electronic and telecommunications technologies and services used to provide care and services at-a-distance. On March 6, Congress passed the Telehealth Services During Certain Emergency Periods Act of 2020 as part of the Coronavirus Preparedness and Response Supplemental Appropriations Act. This legislation makes it easier for medical providers to practice telehealth by temporarily waiving certain Medicare requirements and regulations. It appears that this will introduce more medical providers to this type of treatment, which may expand telehealth options around the country.

While telehealth has been available for some time before the pandemic, it was normally only used for independent medical exams in which there were geography constraints. Today, in many cases, telemedicine is the only option injured workers have for evaluation and treatment. Medical providers are utilizing video chat and other software to provide virtual consults and follow-up visits. Virtual physical therapy is also increasing in availability and utilization. Fortunately, because of these innovations, injured workers are not missing out on the treatment and therapy needed to rehabilitate their injuries.

2. Virtual Mediations. As a mediator, I avoided telephonic mediations as much as possible. On the telephone, rather than in person, it is more difficult to gain rapport and impossible to pick up on non-verbal cues, such as body language and facial expressions. Although sometimes necessary when a party is in a remote location or travel is otherwise not an option, telephonic mediations were never my first choice.

Mediation through video conferencing, however, is becoming more readily available and seems to be a much better option when parties are unable to come together in-person. Video conferencing software is now more robust, affordable, and accessible than ever before. Through video, parties can feel more immersed in the process and mediators can more easily gain rapport with the participants and be able to understand the issues that need to be resolved. While not as effective as in-person mediation, virtual mediation is a worthy alternative to consider in these times.