Enhancing our claims management services
unum.co.uk
Welcome to the third in a series of publications that explore Unum’s continually evolving claims management capabilities. We have always said that we do not just assess claims but that we manage them, seeking solutions that are best for all concerned. In a recent Watson Wyatt survey , 22% of employers stated claims management capabilities as being very important in selecting their current insurer. With this in mind, within this paper we bring you news of a number of enhancements to our claims management services; including the introduction of telephonic claims form completion options and proactive identification of potential claimants from employer records.
Watson Wyatt Healthcare and risk consulting; 2007 risk benefit survey report.
Group Income Enhancing Protection
Evolving: In 2005, we introduced the concept of the biospsychosocial (BPS) model in our Evolving publication. We explained that through our day-to-day observations of claims and our links with the Unum Centre for Psychosocial and Disability Research at Cardiff University, we had grown to wholeheartedly embrace the BPS model. The essence of the BPS model is that as well as the bio factors, which are universally accepted, we must also consider the powerful role that the psychological and social factors can play in both a person’s initial and then potentially prolonged incapacity. Bio – Neurophysiology, physiological dysfunction Psycho – Illness behaviour, beliefs, coping strategies, emotions, distress Social – Culture, social interaction, sick role. Within Evolving, we also introduced the re-alignment of our claims teams around brokers and employers to give customers a single point of contact within our claims organisation.
Enabling:
At the same time, we have been working to enhance our claims management service. The wealth of changes, which are available from October 2007, are designed to improve the speed and flexibility of our claims management services; you can read about the changes on pages 5, 6 and 7.
Our People – the reason we don’t need to outsource Unum’s people really believe in making a difference. Within our Customer Care Division, which is made up of our Claims, Medical Services, Rehabilitation Services and Technical Medical Underwriting departments, we have a large number of specialist staff helping to ensure that each claim is dealt with in a timely, fair, appropriate and professional manner. Unlike many other insurers, all of our core services are in-house as this ensures good communication between all parties, and ready availability of appropriate advice and opinions. Quality and continuity of service provision is guaranteed, which can be difficult to achieve with outsourced service providers. As well as this, all our people have security of employment and know that this protects the independence of their views.
In 2006, our Enabling publication announced the introduction of a new Medical Underwriting application form which would make it possible for very high amounts of income protection cover to be granted without the need for a GP’s report. This change was underpinned by our knowledge and belief in the BPS model.
Enhancing: It is now two years since we published Evolving, and one year since we published Enabling; what has changed? We are continuing to build on what has proven to be a very successful model. In terms of medical underwriting, 86% of our income protection cases are currently being processed without the need for any medical evidence, and we are fast approaching our target of 90%.
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Our Core Services: Medical Underwriting
Medical Services
Alongside our team of specialist Medical Underwriters, who are all specifically trained in Income Protection Insurance, we have a specialist Technical Underwriting team led by our Chief Medical Underwriter. The team research our claims experience, changes in medical thinking and draw on the lessons from the Unum Centre at Cardiff to ensure that our approach to underwriting is scientific, up to date and in line with our experience.
Our Medical Services team consists of eight nurses and two doctors. Our nurses are aligned with the Claims teams to ensure that the team have ready access to advice both on an ad-hoc and more formal basis, and so that our nurses can attend round table discussions on claims. This helps us to streamline our approach to assessing claims, enabling timely decisions as far as is possible.
Claims team Our team of over 80 Claims Management Specialists and Managers undergo rigorous training and assessment, with authority levels strictly linked to proven competencies and experience. They work in teams closely aligned with employers and intermediaries to ensure that strong relationships and understanding of clients’ needs, specific requirements and difficulties are formed. Each Claims team has a dedicated Insurance Nurse Specialist who advises on the medical aspects of claims and assists in arriving at the correct decision as quickly as possible. Each team also has dedicated Vocational Rehabilitation Consultants (VRCs) who provide guidance on the potential for rehabilitation in individual cases, and also an understanding of a particular customer’s needs in relation to absence management. Claims decisions are not made by individuals alone, but are made in round table discussions, where a Manager or Senior Claims Management Specialist and a member of the Medical Services team will provide input. Our Customer Care Director is also medically qualified with extensive expertise in Disability Assessment Medicine.
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Our two doctors, who have expertise in the field of Disability Assessment Medicine and Occupational Medicine, have input both into Claims and Medical Underwriting, as well as providing a source of medical advice for our Rehabilitation Services team. The annual Unum Chief Medical Officer’s Report is recognised as thought-provoking and informative on issues relevant to sickness, disability and employment.
Rehabilitation Services We have a team of 30 Vocational Rehabilitation Consultants (VRCs) who come from a variety of backgrounds including psychology, nursing, physiotherapy, and occupational therapy. They are dedicated to finding solutions for employees and employers when disability strikes. They can provide guidance on adjustments to enable employees to return to work and, in consultation with the employer, employee and their GP, can develop graduated return to work plans. The VRCs act as a bridge between employers, employees and doctors to ensure that communication does not break down and that barriers to work are dismantled wherever possible. This ensures that absences need not be any more prolonged than necessary and that return to work is sustained once achieved.
Enhancing
Enhancements to our services We are always looking for ways in which to improve the Unum customer experience. The following initiatives, which will be available from October 2007, illustrate our commitment to ensuring that we meet our customers' needs, now and in the future. The initiatives below are all optional additions to the existing services that we offer.
Improved communications: Proactive Identification of Potential Claimants from Employer Records Where employers have the appropriate records, they can send us a monthly list of absent employees, setting out details of their date of first absence and its cause, along with details of their line manager. We keep track of this information and filter the list to identify those employees who may benefit from early intervention, rehabilitation support or those where the claims process needs to start. Most insurers state that if there are significant delays in claim notification then they have the right to decline a claim. This makes early receipt of claim forms an important issue, especially when you consider that, according to a recent Watson Wyatt survey, 42% of employers notify their insurer of an employee's absence after their employee has already been off work for 13 or more weeks. Late notification is clearly a problem for both employers and insurers; our pro-active identification of potential claimants from employer records will help to avoid this situation. Telephonic Claim Form Completion We are now able to offer telephonic completion of claim forms to any customers who would like this service. We are able to complete both employer and employee claim forms over the telephone, ensuring that all relevant questions are answered fully, and therefore removing the delays associated with having to obtain further information. Postal delays are also significantly reduced.
Electronic Claim Forms All claim forms are available to customers in a secure manner via e-mail and PDF as well as on paper. Customers can then either complete them electronically and return by e-mail, or print them off to be completed and returned by post, according to their choice. Dual and Combined Consent Forms Consent to seek and share information is critical during all stages of absence. We require permission to seek information from doctors in order to be able to provide guidance on rehabilitation as well as in order to assess claims. This information needs to be shared as appropriate, but consent from the individual concerned is of paramount importance for both ethical and legal reasons. Dual Consent Form This form enables us to obtain and share information with the employer. It is dual branded with both the employer’s and Unum’s logo. The form is advantageous as it allows us to fully explain our liability decisions to the employer, thereby increasing their understanding of the reasons behind our decisions. This should not only help to prevent any misunderstandings, but will also allow a more open dialogue in the rehabilitation scenario, ensuring all parties understand the rehabilitation plans and have knowledge of the medical factors affecting the claimant. Combined Consent Form This is a single form combining two, formerly separate, forms. It allows Unum to obtain medical information both for rehabilitation and claim purposes. This is advantageous when we undertake rehabilitation prior to the claim as we then have consent to obtain medical information when it is the appropriate time to start the claim process. This prevents delays and speeds up the claims process.
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Both forms are designed to enable a seamless transition between early intervention from rehabilitation, into claims assessment and management. The forms also encourage good communication between employers, Occupational Health Providers and Unum, ensuring that all relevant information is shared as appropriate. Choice of Preferred Communication Method All customers will be able to choose their preferred method of communication with us (PDF/e-mail/telephone/letter) to suit their system requirements. Use of Plain English in Claims Communications Plain English is used in all claims communications, avoiding the use of jargon wherever possible, and explaining technical terms where their use is unavoidable. This enables easier understanding of claims decisions and aids ongoing communication. Claims Guide The Group Income Protection (GIP) claims process is often poorly understood, both by claimants and their doctors. To help all parties have a better understanding of what employers and claimants can expect from us when they submit a claim, we have developed a brochure entitled Your Guide to Claiming Group Income Protection. This brochure guides our standard GIP, Capital Option and Pay Direct customers through various subjects such as; when and how to submit a claim, how Unum makes claims decisions, and how benefits will be paid. The brochure is sent out to all new policyholders. As an additional reminder, a brief one page document is sent out with the forms which go to the employer, employee and GP once the claims process has started. This helps to set expectations when the customer or GP may not remember or may not have seen the information in the brochure. For a copy of Your Guide to Claiming GIP, please visit our website www.unum.co.uk
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Enhanced services: Customer Site Visits Unum’s Rehabilitation staff routinely make site visits to customers' premises when working on rehabilitation for their employees. However, where customers who have claims with us request it, Claims Managers and Claims Management Specialists are also now able to visit them on at least an annual basis. This enables all parties to understand the position with regard to employment, possibilities for return to work and future claims management options. Monthly Claims Progress Reports We are able to provide monthly claims progress reports for all customers who request them. The reports give details of the current position of live and pending claims. This helps to ensure that our customers are kept informed of the progress of their claims without them needing to request this information. “Up-front” Benefit Calculations We shall advise customers of the value of the claim as soon as we have received all of the information necessary for us to calculate the benefit. This will enable us to manage queries and potential disputes in a much more proactive way, avoiding unnecessary delays in payment. Electronic Payment of Claims All claims payments are made by BACS on the third to last working day of each month, removing the need for cheques. This considerably reduces the requirement for paperwork and increases security of the transfer. Notice of remittance is sent to all customers each month.
Additional services: Payment for Treatment Our medical team can work with employers, employees and their medical advisers to identify those cases where additional treatment could help facilitate recovery. In cases where, in our judgement, there is a good prospect of achieving a significantly accelerated return to work or significantly enhancing the likelihood of return to work by use of such treatment, we may agree to share or cover the costs. This applies to treatments which are evidencebased, licensed for use in the UK and which are not readily available on the NHS or through Private Medical Insurance. Telephonic Rehabilitation Case Management A core value of our rehabilitation service is our ability to meet face-to-face with both employer and employee to facilitate a return to work. However, when there is an urgent need for return to work services, which makes it difficult to arrange meetings on a timely basis, we are also able to offer an immediate telephonic service. The telephonic service that we offer prevents any possible delays and ensures the employer has access to information on best practice right away, to effect a successful return to work. This can also be of use where the employee is still in work, but not on full duties or hours due to an illness or injury, and the employer is simply looking for information to assist their management of the situation. Good Relationships with Clients’ Occupational Health (OH) Providers Our Medical Services team includes experienced OH Specialists. Where possible, we have regular meetings and conversations with our clients’ OH Providers to ensure that all parties are aware of and have a good understanding of any relevant medical issues and are therefore interpreting evidence in a similar way. This helps not only to facilitate good working relationships, but also ensures that the employer is in the best possible position to understand outcomes.
Enhancing
And finally: Nine out of ten people who go off sick from work and who are subsequently in receipt of Incapacity Benefit do not foresee that their incapacity may be prolonged and usually intend to get back to work . Unfortunately, this does not always happen. It is this that drives us to continue our work into understanding disability and come up with solutions that can help employers and their employees to find suitable solutions at difficult times in their lives. Unum has been specialising in Income Protection Insurance in the UK since 1970. In the 37 years that have passed, we have grown to be the leading provider of Group Income Protection Insurance in the UK. As our knowledge, experience and understanding of this complex area has grown, so too has our hunger to drive and enhance the market in terms of delivering leading edge theories, concepts, products and services.
Waddell G Aylward M 2005, The Scientific and Conceptual Basis of Incapacity Benefits. The Stationery Office, London.
About Unum Unum is the UK’s leading provider of group income protection insurance, with over 35 years of experience. Our critical illness and life insurance products enable our customers to purchase complementary protection solutions that together make up a comprehensive protection package. Our income protection customers benefit from our expertise in the specialist areas of disability, rehabilitation and return-to-work. We enable individuals to protect their incomes, ensuring their financial security if they are unable to work because of illness or injury. For employers, we offer Group Income Protection policies which provide insurance cover for employees’ salaries and safeguard one of their most valuable resources by helping employees return to work following long-term absence. At the end of 2006, Unum protected almost 2 million lives through more than 18,600 schemes. During 2006 we paid total benefit claims of £285 million – of which more than £191 million related to income protection claims. Our US parent company, Unum Group, traces its history back to 1848 and is today the market leader of group and individual income protection insurance in the United States. Premium income for Unum Group and its subsidiaries exceeded $7.9 billion in the year ended 31 December 2006. Total assets were $52.8 billion at 31 December 2006. For more information please visit our website.
unum.co.uk Unum Limited is authorised and regulated by the Financial Services Authority. Registered in England 983768. We monitor telephone conversations and e-mail communications from time to time for the purposes of training and in the interests of continually improving the quality of service we provide. Copyright © Unum Limited 2007
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UP1441 09/2007