The News You Need Jan. 18

Feedback loops and CLM previews.

Developing a Claims Feedback Loop: Elevating Workers’ Compensation Through Continuous Input?

Dr. Claire C. Muselman

Roadmap

An effective workers' compensation program isn’t static—it evolves based on real-world insights and continuous feedback. Developing a claims feedback loop is a powerful way to gather input from injured workers, claims adjusters, and other stakeholders, using their experiences to enhance policies, processes, and outcomes. This article explores how to create a structured feedback system that drives improvement and builds a more supportive workers’ compensation program.?

Why a Claims Feedback Loop Matters?

The claims process is a critical touchpoint for employees and employers, and every interaction offers valuable insights. A structured feedback loop captures, analyzes, and acts upon those insights, leading to better outcomes for injured workers and a more efficient workers' compensation program. The key benefits of a claims feedback loop include and are not limited to:??

Improved Processes. Feedback helps identify inefficiencies or pain points in the claims process, paving the way for targeted improvements.?

Enhanced Employee Trust. Engaging injured workers in feedback demonstrates that their experiences and opinions are valued.?

Informed Decision-Making.?Real-time feedback provides actionable insights to guide policy and process changes.?

Better Communication. Open feedback channels encourage transparency and collaboration between all parties involved in the claims process.?

Stronger Outcomes.?Continuous feedback leads to refined practices that improve recovery times, reduce disputes, and enhance satisfaction.?

Steps to Create a Claims Feedback Loop?

Identify Feedback Channels.?Establish clear and accessible ways for injured workers, adjusters, and other stakeholders to share their feedback. A variety of feedback methods ensures inclusivity and captures diverse perspectives.?

Examples of feedback channels:?

Surveys. Use digital or paper surveys to gather structured input about the claims experience.?

Focus Groups.?Host small group discussions with injured workers or adjusters to explore common challenges and solutions.?

Post-Claim Interviews. Conduct one-on-one interviews to gain in-depth insights after resolving claims.?

Anonymous Submissions.?Allow stakeholders to provide feedback anonymously to encourage candid responses.?

Engage Stakeholders Regularly?Consistent engagement with all involved parties ensures the feedback loop remains active and meaningful. Regular engagement keeps the focus on continuous improvement and fosters a collaborative approach.?

Key stakeholders to involve:?

Injured workers who can share their firsthand experiences navigating the claims process.?

Claims adjusters who provide insights into challenges and successes from their perspective.?

Supervisors and HR teams who can identify systemic issues or areas for improvement.?

Medical providers who can highlight communication gaps or process inefficiencies.?

Analyze and Prioritize Feedback?Collecting feedback is only the first step—analyzing the data and prioritizing actionable insights is where real change begins. Structured analysis transforms raw feedback into meaningful actions.?

Steps to analyze feedback:?

Categorize Responses—group feedback into themes, such as communication, timeliness, or return-to-work processes.?

Identify Patterns.?Look for recurring issues or suggestions to pinpoint areas needing attention.?

Prioritize Changes.?Focus on high-impact areas that can improve the injured worker’s experience and program efficiency.?

Acting on Feedback?

The effectiveness of a claims feedback loop depends on the organization’s ability to translate insights into concrete changes. Taking action demonstrates a commitment to improvement and builds trust among stakeholders.?

Refine Claims Processes.?

Use feedback to streamline and improve claims handling procedures. Actionable improvements make the system more efficient and supportive.?

Reduce Delays.?Address bottlenecks that injured workers or adjusters identify in the process.?

Enhance Clarity.?Simplify communication and documentation requirements based on user feedback.?

Improve Accessibility.?Make the claims process more user-friendly by incorporating suggestions for better technology or resources.?

Update Policies and Training.?

?Incorporate lessons from feedback into organizational policies and employee training programs. Continuous updates ensure the program remains responsive and relevant.?

Policy Updates.?Revise policies to reflect feedback-driven improvements, ensuring they align with best practices and stakeholder needs.?

Training Enhancements.?Train claims adjusters, supervisors, and employees on updated processes to reinforce consistency and efficiency.?

Scenario-Based Learning. Use honest feedback examples to create training scenarios that prepare teams for everyday challenges.?

Close the Loop.?

Communicate the changes made due to feedback to stakeholders, completing the feedback loop. Closing the loop reinforces trust and emphasizes the organization’s commitment to listening and learning.?

Share Updates.?Inform injured workers, adjusters, and other participants about the improvements implemented.?

Acknowledge Contributions.?Recognize the value of stakeholder input and encourage ongoing participation.?

Track Outcomes.?Monitor the impact of changes and use new feedback to refine practices further.?

Challenges and Solutions in Developing a Feedback Loop?

Low Participation Rates.?Encouraging stakeholders to provide feedback can be challenging, especially if they feel their input won’t lead to change.?

Solution:?Promote the feedback process as an opportunity for stakeholders to shape the program and highlight examples of how past feedback has driven improvements.?

Overwhelming Data. Large volumes of feedback can be challenging to manage and prioritize effectively.?

Solution: Use technology like feedback management tools or analytics software to organize and analyze data efficiently.?

Resistance to Change.?Implementing changes based on feedback may face resistance from internal teams.?

Solution:?Involve key stakeholders in the change process to foster buy-in and emphasize the benefits of proposed improvements.?

Measuring the Impact of a Feedback Loop?

To ensure the feedback loop drives meaningful improvements, track key performance indicators (KPIs) that reflect program effectiveness. Reviewing these metrics ensures the feedback loop remains effective and aligned with organizational goals. Some examples of KPIs to monitor include:??

Satisfaction Scores.?Measure satisfaction levels among injured workers and adjusters before and after implementing changes.?

Claims Resolution Times.?Track whether process improvements lead to faster claim resolutions.?

Employee Engagement.?Assess participation rates in feedback initiatives as a measure of program relevance.?

Error Reduction.?Monitor decreases in common claims processing errors based on feedback insights.?

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Building a Culture of Listening?

Developing a claims feedback loop is a commitment to fostering a listening and learning culture. When organizations actively seek input from those directly involved in the workers’ compensation system, they gain valuable insights that drive innovation and build trust. A culture of listening strengthens relationships and creates a foundation for continuous improvement.?

Tips for sustaining a culture of listening:?

Regular Feedback Opportunities.?Make feedback a standard part of the claims process to normalize input collection.?

Leadership Support.?Ensure leaders champion the feedback loop and prioritize implementing changes.?

Celebrate Successes.?Recognize stakeholders for their contributions to improving the program.?

Turning Insights into Action?

A claims feedback loop is an essential tool for evolving a workers' compensation program to meet the needs of all stakeholders. Organizations can create a more transparent, efficient, and supportive process for injured workers and their teams by collecting, analyzing, and acting on feedback. With a well-designed feedback loop, every claim becomes an opportunity to learn, improve, and deliver better outcomes.?

5 Questions for Kirsten Kaiser Kus on Trends, Risks, & an Upcoming CLM Session

Frank Ferreri

In advance of the CLM Focus Conference coming up Feb. 11-12, we're presenting a series of conference-preview pieces to better understand what the sessions will offer and why they're relevant to the workers' compensation industry. Today, we catch up with Kirsten Kaiser Kus, who will present Navigating New Trends and Risks in Work Comp Cases alongside Evelyn Eury, Ya'Sheaka Williams, and Ron Carter.

Q: How would you define or describe "emerging trends getting out of hand" and why that issue is important?

KK: Each year, new events, technologies, legislation, and behavioral patterns alter the workers’ compensation insurance landscape. The way Americans work is always changing, and these changes carry accompanying risks. It is crucial that insurers and their defense counsel stay up to date on these trends and continually reassess how to respond to new developments as they arise. This requires us to look up from our work and think about the big picture, but in doing so, we can greatly improve the way we analyze and respond to claims. The field of workers’ compensation involves a relationship between three groups: defense counsel, employer, and carrier. As a mediary between the two, defense counsel is in the best position to notice these trends, develop a response plan, and communicate their recommendations back to the carrier and employer to reduce the number and severity of claims.? Telemedicine, excessive medical treatment of injured workers, catastrophic claims and opposition to nurse case managers by the Plaintiff bar are just some of the topics that will be discussed.

Q. Who should attend this session, meaning who stands to?learn the most and can put what's learned into action?

KK: Employers, risk managers, claim handlers and defense counsel will all benefit from this session to proactively have a plan in place to prevent these issues which significantly increase litigation and the cost of their claims.? These attendees will also learn what to do if they are faced with one of these issues and how to mitigate and minimize exposure.

Q. What experiences have you had that have led you to this topic and presenting on it?

KK: Regarding telemedicine, it is great for certain types of medical specialties, like psych.? However, I have seen a broken bone diagnosis missed because an initial injury was treated via telemedicine so no diagnostics were completed.? It needs to be used in the right cases.

Plaintiffs abusing medical treatment has been an ongoing issue for our industry.? In my state, I am able to use discovery, surveillance and depositions to try and put a halt to treatment.? I can then take the information I learn from these tools and request a narrative from a treating physician and highlight the inconsistencies in Plaintiff’s complaint in office versus their true daily living activities and prior medical treatment.

Nurse case managers and catastrophic claims go hand in hand as a good nurse case manager can help facilitate treatment and make sure the proper physicians are providing necessary treatment to get claimants to maximum medical improvement and the best recovery possible.? Nurse case managers being villanized by the Plaintiff bar is completely unacceptable and I have addressed it with the Hearing Members to get opposing counsel in line.

Q. With the knowledge gained from this session, what will attendees potentially have in their professional "toolboxes" that they didn't have before the session?

KK: Attendees will be able to spot potential issues to prevent them from happening or if they do arise, they will be able to use these tools to minimize the costs of their claims and get these injured workers to maximum medical improvement. Minimizing risk and cost of claims by preventing these issues and being able to stop them early before they spiral into extended litigation will be extremely helpful.

Q. What about this topic and session do you find makes you feel proud about presenting on it?

KK: I take pride in great communication with my clients, ways to think outside of the box to defend my client’s claims and doing everything I can to minimize their overall claim cost.? Educating our community is crucial and I am always happy to do so for my current clients and anyone that reaches out with an issue, even if they are not my client.?