This is the final article of a four-part series that also includes an overview and articles further exploring the survey’s implications for product development and underwriting. For more information, view the survey infographic and full survey report.
RGA’s global survey revealed several potentially actionable insights in the area of claims management, highlighting the significant role insurers can play in shaping mental healthcare practices and outcomes moving forward.
Dedicated Specialist Resources for Mental Health Claims ManagementRGA’s global survey yielded various responses regarding the evolution of processes aimed at supporting the mental health of claimants through specialist resources and value-added services, particularly for disability products. Most notably, 43% of the surveyed insurers disclosed their use of dedicated claims management resources specifically tailored for mental health cases. While North America (63%), Australia/New Zealand (56%), and EMEA (30%) reported the use of such resources, the Asia-Pacific (APAC) region reported no use. This might be attributable to a range of factors within APAC, including the lower prevalence of disability products and the developing healthcare infrastructure. |
Key Takeaway: The use of specialist resources for mental health claims management in certain regions highlights the potential benefits of specialized mental health support, while the limited amount or lack of such resources in other regions offers an opportunity to make significant strides in this area. |
Effective Claims ManagementThe survey also delved into the skills most needed to effectively manage claims involving a mental health diagnosis. Results confirmed that claims managers require a combination of technical and interpersonal skills. 26% of respondents identified communication abilities as the highest priority area for future professional development, presenting an opportunity to invest in training and development initiatives. Other responses, and areas of opportunity, included: What claims management skill sets (to manage mental health-related claims) require further development or are currently absent from your claims team? |
Global | Americas | EMEA | APAC | AUS/NZ | |
Verbal and non-verbal communication skills to communicate with the claimant, treating health professionals and other stakeholders (e.g., employer, extended family, etc | 26% | 33% | 14% | 22% | 29% |
Analytical skills to understand the demands of an occupation and the potential impact a mental health condition may have on a person’s ability to perform everyday life activities | 21% | 21% | 25% | 19% | 25% |
Planning skills to create a claims management strategy to assist appropriate return to work and functions | 20% | 22% | 22% | 13% | 19% |
Sufficient medical knowledge of mental health conditions | 18% | 15% | 3% | 43% | 8% |
Awareness and understanding of resources available that can be included as part of the claimant’s care plan | 13% | 8% | 34% | 4% | 13% |
Key Takeaway: While 82% of survey respondents reported that they agree/strongly agree that their company has the required skill sets to adequately manage claims with a mental health diagnosis, these results are in contrast with feedback from claims professionals as part of RGA’s qualitative survey interviews. Claims respondents from all regions indicated it has become very difficult to find and retain people with the breadth of necessary expertise to handle these complex types of claims and, in particular, to communicate on complex claims management aspects with various stakeholders. |
Disability and Income ProtectionDisability and income protection products dominate mental health-related services currently offered by insurers. Among survey respondents offering these products, 50% provide access to counselling networks staffed with mental health experts, reinforcing the need for professional guidance. Additionally, 41% offer interventions specially designed to facilitate claimants’ successful return to work, while 39% offer virtual medical care to support overall wellbeing. Beyond the services offered, the survey results also highlight critical challenges in disability claims assessment and management. The top-rated concern was the difficulty receiving support from attending physicians in facilitating return-to-work efforts, underscoring the importance of collaboration between insurers and healthcare professionals. Collaborating closely with physicians can alleviate claimant reluctance to return to work, but this requires careful planning, extensive communication, and the appropriate resources to enable these conversations. |
Key Takeaway: The insurance industry has a vital role to play in educating primary care and specialist healthcare professionals about the value of work in improving health outcomes. At its core, success hinges on communication – an area where insurers generally face challenges. The key will be driving all stakeholders towards structured and targeted claims management that focuses on return to work. |
Other challenges reported by insurers: |
Vice President, Global Head of Claims
RGA South Africa
Mental health claims are complex and rarely fit into particular constructs. Acknowledging and addressing multifaceted factors involved in complex undertakings such as the return-to-work process is crucial. The ability to identify these nuances enhances credibility with claimants, employers, and treatment teams. Neglecting to do so erodes alignment and trust and creates conflict. The application of the biopsychosocial model remains instrumental in understanding these complexities and implementing comprehensive solutions.
The insights gained from RGA’s Global Mental Health Survey highlight that insurers have a significant role in shaping the mental health landscape. By proactively addressing the gaps in education, communication, and claim complexity, the insurance industry can contribute to improved mental health support and return-to-work processes. The commitment to bridging these gaps not only leads to smoother claims processes but also reaffirms the industry’s dedication to policyholders’ overall wellbeing.
Contact us to learn more about survey insights and how RGA is helping insurers meet the growing demand for mental health coverage.
Behavioral science techniques can help facilitate return to work after a temporary disability. However, insurers often find it hard to effectively implement these techniques into a claims journey. They must be embedded throughout the process, and claims handlers play an important role in their delivery.
RGA partnered with a client to conduct a trial on the topic. The results showed that, for a small investment of time, best-practice behavioral science techniques can be incorporated into every phase of the claims process, from filling out claims forms and triaging cases to communications, whether on the phone or via email and SMS (text) messages, between claims assessors and claimants.
Click here to learn more about RGA’s Behavioral Science Toolkit that includes a number of training modules, a webcast, and a podcast, which provide insights into opportunities to improve the claims experience for insurers and their customers.
