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When discussing Income Protection claims, the term “early intervention” is frequently referenced within claims philosophy and process manuals, but it may not be fully understood or actioned as frequently as it could be. This blog aims to increase claims assessors’ familiarity with early intervention and the importance of both rehabilitation services and motivational interviews for improving return-to-work outcomes.
Early intervention refers to the proactive and supportive contact between the Claims Assessor and the insured, as well as other stakeholders such as the employer, the treating physician, and the rehabilitation provider. This all begins with the engagement of the insured, which is a key factor in facilitating a successful and timely return to work.
Engage with insureds early in the process. The aim is to establish a trusting and collaborative relationship, to assess an insured’s needs and barriers, to provide information and guidance, and to initiate a return-to-work plan. As indicated by the word ”intervention”, the Claims Assessor should be intervening to help support the Insured with their return-to‑work.
It is not uncommon for an insured who does not successfully return to work following an injury or illness to experience negative consequences such as financial strain, family tensions, further health deterioration, and employment difficulties. These may be exacerbated by cumbersome claim initiation processes that then may delay communication from the insurer.
Statistics from Comcare (the Australian government) show that the longer a worker is absent from work, the less likely they are to return to work. According to their data, if a worker is off work for 20 days, the chance of returning to work is 70%; if they are off work for 45 days, the chance drops to 50%; and if they are off work for 70 days, the chance further declines to 35%.1
These statistics aren’t new or perhaps entirely unexpected; however, considering that most Income Protection products have a waiting period (for example, products within the Australian market commonly have a 30‑day waiting period) during which time a claim has commonly yet to be lodged, the data highlights just how crucial early intervention is to prevent long-term work absence and its associated costs and impacts. Given the implications, there should be a significant element of urgency to initiating the early intervention process.
The telephone is possibly the most powerful tool at a Claims Assessor’s disposal and should be preferred over other methods of communication with the insured. Among its advantages, phone conversations allow the Claims Assessor to explore topics in depth and to provide information regarding the claims process and supports available while also gaining other information not traditionally covered in claim forms such as the insured’s attitude or confidence towards returning to work. Phone conversations also can be used to conduct motivational interviewing, a counselling technique that helps the insured find their own motivation to change their behaviour and overcome ambivalence (if present).
These skills help the Claims Assessor build rapport, elicit change talk, resolve resistance, and enhance self‑efficacy.
There is no definitive answer as to when an insured should be connected with rehabilitation providers to commence return-to-work discussions. The timing for that engagement may depend on the nature and severity of the injury, the availability and suitability of the provider, and the preferences and needs of the insured. However, once it has been identified that an insured will require support with return-to-work planning, the Claims Assessor should look to engage the insured with a rehabilitation provider as soon as possible after their injury or illness. Rather than waiting for the insured to fully recover from their condition, the insured should be encouraged to partake in some tasks while regaining function during their recovery journey.
Employees may have conversations with their employer quite early in the process; self-employed individuals, however, may struggle with the process and may not have experience in how to manage it. This highlights the need for an in‑depth understanding of the insured’s pre-disability occupation and the functional requirements needed to perform each facet of their work to identify what they can do. Again, this is particularly important for self-employed individuals as they often do not undertake defined roles or have documented occupational duties.
The pre-disability duties of an occupation can be explored by different means such as a job description, occupational questionnaire, in‑depth phone discussion, or, ideally, via a worksite assessment conducted by a rehabilitation provider. It is not appropriate just to take a job title on face value for "own occupation” definitions since the functional demands of individual roles vary. For example, not all truck drivers are required to physically load their vehicles, therefore the physical demands for truck drivers can be vastly different.
The impact of the pandemic on the workforce has also created greater flexibility in the ways we work, in particular with the increased viability of working remotely. Some companies have embraced this change and have noted that there was little impact on productivity. Working remotely has created flexibility beyond removing the requirement of having to travel to an office; it also generally changed the hours during which an employee is required to complete their work. This is particularly helpful to an insured while recovering because it gives them the ability to pace their work duties while managing fatigue, pain, and cognitive issues. Working from home rather than an office can also allow for a work environment customised to their functional abilities, including removing potential barriers. A rehabilitation provider can use their expertise to help organize the insured’s home working arrangements. Working from home, however, has its own challenges, among them feelings of isolation and less readily available support. These elements need to be monitored closely. Being able to recover while working benefits the insured by allowing them to gradually rebuild stamina and regain confidence and identity while also setting the expectation that the insured can and will successfully return to work.
Early intervention for Disability claims is an important factor in supporting and influencing a return to work. By using the telephone, rehabilitation services, and motivational interviewing techniques, Claims Assessors can establish a positive relationship with insureds, assess their needs and barriers, provide information and guidance, and initiate a return-to-work plan.
More broadly, early intervention can help prevent long-term work absence and its negative consequences for claimants, employers, and society.
