Stalled Claims Could Benefit from These Technological Innovations in Workers’ Compensation: Risk and Insurance


The use of analytics and even virtual reality to address behavioral health issues in workers’ compensation claims is gaining more attention.

The picture of workers’ compensation medical management has become increasingly complicated as the industry reckon with the forces of a post-pandemic world and the changing nature of work, but the issues remain the same: support injured workers to promote return to work.

To get the green light from all parties involved in a grievance, employers and worker service providers are accepting new ideas in ways that were previously unimaginable.

Behavioral Health Technology and Innovation

“Behavioral health issues have always been present in workplace accidents. Society’s awareness is growing, and as it improves, it’s slowly starting to change the way we recognize it in the labor compensation industry,” said Dr. Kathleen Fink, Medical Director partner, Optum.

“Years ago, there was a change to improve by integrating the treatment of psychological problems with the medical condition. You didn’t have to treat under a separate psychological diagnosis; you treated under the medical condition. We thought it would open doors and allow people to get the treatment they needed, but unfortunately it has been very slow to move forward. »

Recently, however, as the rise of the biopsychosocial model of care in both worker and group health has manifested itself, progress has been steady – in particular, the use of technology to identify the risk of behavioral health problems such as depression and anxiety.

Companies are investing heavily in tools that range from virtual reality to automated risk scores.

“Every work’s compensation injury is a behavioral health injury, and that’s something that’s now being realized as part of workers’ compensation claims — it’s not something that’s changed,” Dorothy Riviere explained. , Chief Medical Officer of Bardavon Health Innovations.

“I’ve been a physiotherapist for over 20 years and we spend a lot of time with injured workers, probably more than almost any medical touchpoint we have. Therefore, we had to understand the connection between a patient’s physical recovery and behavioral recovery. We’ve always said that if you can get a patient to say, “I think I’m going to get better,” most of your work is done. The hardest part of your job has been done – the rest is about using your skills and knowledge to improve your physique.

Bardavon recently acquired PeerWell to focus more on biopsychosocial in practice by providing injured workers with digital musculoskeletal injury treatment techniques to use in combination with the clinical setting.

Beyond the norm

Physique enhancement has grown to include more than typical modalities for innovators in the space, especially when it comes to the combined treatment of behavioral health and pain management, a near constant when a complaint stagnates.

“Whenever we hear someone talk about what they can’t do and their pain, especially if we can’t relate it to something physical, it’s important that we understand what might be affecting them. “said Melissa Burke, vice president, lead or claims integrated solutions at AmTrust.

Burke’s organization has prioritized cognitive behavioral therapy as a key treatment for claims stuck with mental health components, and has had excellent results.

“We have to look at how the injury happened. In one case, we had an employee who was cut in the face during a burglary of his location. Her injury healed, but the PTSD associated with it was what really kept her from returning to her job. We needed to provide her with these resources and connect her with someone who could help support her. These are the elements that we must constantly think about. These are the questions we ask – how do they focus on their abilities? »

In addition to asking the right questions, workers’ compensation medical management experts have completely turned their backs on using analytics to inform claims adjustment functions that were once time-consuming and error-prone in due to volume.

These tools have the added value of increasing the likelihood that an expert can take the time needed to ask the right questions.

“Using the data we have, we are able to use the analyzes to stratify patients,” explained Dr. Fink’s method of Optum.

“These data points can be medications, refills, number of medications, diagnosis, how far they are from their injury – all of these things can point us in one direction. A person recently injured in a car accident may experience some anxiety associated with that injury. With layering you can do an intervention, an assessment, and then further treatment can take place, including coping mechanisms and relaxation techniques, even virtual reality for desensitization to get them back in the car without this involuntary panic response, which may lead to better outcomes and is a non-pharmacological treatment.

VR trend

The use of virtual reality (VR) in particular has been a trend driving substantial investments in healthcare, especially for chronic pain, and its beneficial uses for the practice of clinical psychology are well documented in research. peak.

Karen Thomas, Director, Case Management Innovation, CorVel

A 2022 research review published in Dialogues in Clinical Neuroscience found that, especially for exposure-based treatments like the one Dr. Fink’s patient found success with, VR may be the next generation of treatment for show significant benefits.

However, the authors note that innovative approaches to using virtual reality still have a long way to go, and there are persistent cost and access barriers.

Yet virtual reality for chronic pain continues to gain attention. A 2021 narrative review in the Journal of the Association of Anesthetists showed that 12 of 18 studies under review found reduced pain scores in acute or chronic pain. The types of pain studied also revealed an impressive breadth: researchers used virtual reality for labor pains, dressings and various chronic pains.

Similar to Optum, CorVel has used virtual reality successfully.

“It’s really critical to start educating people early on, to help them understand the pain and its causes, so they can deal with it proactively, not just with medication,” said Karen Thomas, Director, Case Management Innovation, CorVel.

CorVel has partnered with Harvard MedTech to offer a combination of virtual reality and behavioral coaching to help with pain, depression, post-traumatic stress disorder and anxiety. This is in addition to the clinical support built into the model, which begins with 24/7 triage nurses and is followed by a transition to early intervention advocates – those nurses who pick up where triage nurses stop.

“We use our technology, the loss risk score. Care progression nurses document in our system the attitude, feeling and belief that we identify early on, and which may lead to pain management issues, so that we can get ahead of the game,” said Thomas explained.

As with Burke and Fink, with Thomas’ program, the holistic approach has enabled the kinds of successes that the workers’ compensation industry applauds.

“We had a first responder who was recovering well from his medical issues, but was suffering from depression and anxiety, and that started to impact his pain response,” Thomas recalls.

“It was escalating and his wife contacted his case manager about his mental wellbeing. We got him on the connected care program, and with the help of his physician and the connected care physician, and with input from the pharmacist CorVel, they contacted his primary care physician and were able to come up with a care plan that involved support and advice, and he was able to turn around and return to work. He and his wife went on to have another child, and I think it has everything to do with the support he received. &

Nina Luckman is a business journalist based in New Orleans, focusing primarily on the workers’ compensation industry. For the past few years, Nina has served as editor of Louisiana Comp Blog, a news site she launched in 2014 under the auspices of a group self-insurance fund. She can be reached at [email protected]

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