Rethinking Mental Health Claims

June 05, 2014| By Viviane Murphy | Life | English

A person experiencing depression or any other psychological distress is perhaps at the lowest ebb in life. As life insurers, our principal role is supporting customers when their conditions become disabling for them. Part of our role is also to help them work toward wellness and hopefully return to work.

That’s often easier said than done. Managing subjective claims is a big challenge for a claims department, especially in the absence of tangible and objective clinical evidence.

We can offer support for rehabilitation but frequently we don’t invoke a requisite period or requirement for compliance in our policy wording. Also, usually there’s no obligation for the claimant to participate or have an actual diagnosis or see a specialist.

Maybe it’s time to review current disability definitions and create more incentives for claimants to return to work early or make early recoveries.

That means getting the claimant – and his/her physician – to actively participate in treatment to get better. It means establishing a more holistic partnership approach that is neither paper-based nor fully web-based: effectively a no form claim approach.

Such a program would enable the customer to initiate the claim online and access claim information quickly. But it could also provide a prompt to the claim professional to call the customer, explain the process and what is expected, and communicate a voice of authority that helps the customer gain access to his or her treating doctor.

The claim professional could also make a call to the treating doctor to gather the necessary information and initiate a collaborative agreement on treatment, support and timeframes for return to work. This way there’s an immediate impact on the customer’s experience and the process is demystified for the treating doctor. It also helps to unearth any barriers for return to work and forecast the support network required to manage durations.

Three-way communication with the insurer, claimant and GP has long been practised in workers' compensation. I believe this approach can also help life insurers and their policyholders' partners in developing treatment plans and working toward mental health, wellness and recovery.

I also believe that sharing knowledge within the industry is critical to successfully innovating mental health management at claim time and research for product development.

Discussion forums such as Gen Re’s recent interactive webinar, which asked, “How can we better engage treating doctors when it counts the most?” are already leading to a better understanding of what stakeholders want from the process and unlocking potential solutions.

We invite those keen to collaborate to get in touch and share any research, insights or observations.

For more on rethinking mental health claims visit my article in the latest issue of Risk Matters.


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