‘Surge in Litigation’ Expected to Hit Work Comp System in Coming Months

by David Wissel

A wave of increased litigation will likely emerge as workers who have been laid off see their savings run low and start to look for alternative sources of income. The key to addressing this phase will be how organizations conduct layoffs. Companies that initiate layoffs with little forethought and guidance may see a rise in workers compensation claims and experience numerous other unintended consequences. Companies that develop thoughtful reduction-in-force strategies are likely to see fewer workers compensation claims and lower overall expenses.

To avoid this, consider making settlements on open cases despite the lack of hearings or IMEs. Parties may need cash. Negotiations may resolve informally. Some carriers have seen claims moving to settlement early, sometimes at or below reserve estimates. Therefore, the current economic climate may be creating a prime opportunity to resolve stubborn cases.

Additional Disruptions:
The rise of COVID-19 and the ensuing economic recession are crashing at once and creating profound shifts in the workers’ compensation system. Together these waves will drive changes to the workers compensation system for years to come, reshuffle the insurance industry, and could potentially alter health care in the US.

A decrease in traditional workers’ compensation claims, due to fewer workers and fewer work hours will be at least somewhat offset by an increase in new types of claims, including:

• COVID-19 claims.
• Post-termination claims. As waves of workers get furloughed, we can expect a wave of new claims, especially from deeply affected industries such as hospitality and retail. This is driven, in part, by situations where an employee has an injury and may not have filed a claim in a healthy economy but decides to do so in a downturn after seeing his or her bank account run low.
• Work-at-home claims. These may be related to mental stress, sleep deprivation and other conditions related to extended social distancing. Claims for repetitive strain injuries may also increase.

The “onslaught of pent up demand” for medical treatment among injured workers whose care has been delayed will put stress on the system. Some organizations are expanding care networks and establishing new channels of care. A rise in fraud can be expected in the next few months among attorneys and providers known to engage in workers’ compensation fraud. We should see more claims that are challenging to define as legitimate or fraudulent because they occurred in a distributed work environment where there are no witnesses to corroborate the injury.

The following strategies can help organizations prepare for short- and long-term challenges:

• Prepare teams to handle an influx of COVID-19 claims. Also, checking and adjusting reserving estimates should be done more frequently.
• Onboard new tools to increase productivity. New platforms, for example, should be evaluated to help companies prepare for a resurgence when the economy recovers.
• Augment in-house analytics with artificial intelligence. Smart carriers and TPAs are looking for partners that can augment their in-house expertise with AI-as-a-service. This new approach enables them to unlock unstructured insights buried in scans, images, handwritten notes, combine them with structured data from a cross-industry data lake, and generate predictions based on a range of AI techniques. The result is more accurate forecasts overall, and the ability to generate predictions on unique emerging cases, such as COVID-19.
• Expand provider networks. Along with preparing for recovery, incorporating new specialists is also advised; such as pulmonologists and immunologists who can treat conditions such as COVID-19.
• Optimize legal panels.
• Consider settling potentially expensive claims.

If you have any questions, please do not hesitate to reach out. We are here to help.

Dave Wissel is a Client Advisor and Partner at Gulfshore Insurance who specializes in construction, landscaping, and the oil and petroleum industries. Comments and questions are welcome at dwissel@gulfshoreinsurance.com

Please note: The content of this article was taken from workerscompensation.com