Global Claims Views: Raising Claims Management Standards and a New Pathway for Disability Assessment

What is the CMP?

CMP is an all-encompassing claims assessment approach developed by RGA Australia to enhance the assessment processes for disability claims (total and permanent disability [TPD], income protection and group salary continuance). RGA has invested significant resources to create a model that is proactive and holistic, and moves away from a medically focused model that relied heavily on the treating doctor as a gatekeeper for claims decisions.

See also: Claims Management Challenges: Real or Imagined? Internal Industry Pressures (Part I of III)

Most insurers’ existing claims assessment training programs are separate standalone modules; e.g. financial, medical, information-gathering, etc. Where CMP differs is that each training module flows into another and while each can still be undertaken as a separate session ultimately they work together, covering the end-to-end assessment process and providing a guide to best practice claims management.

CMP modules deal with the full term of the claim from notification through on-going assessment until termination. They include the following items:

• Strategy setting: Claims assessors learn a holistic management approach, rather than a process-driven or reactive method of claims assessment, to achieve an appropriate and balanced outcome based on all relevant factors.
• Duration management and risk profiling: The focus of this module is for assessors to utilize the information contained in the Medical Disability (MD) guidelines to predict the lifecycle and duration of a claim. The module aims to provide assessors with the skills and confidence to discuss return-to-work outcomes with claimants and their treating doctors while also improving their understanding of the claimed condition.
• Functional assessment: Here the emphasis is on claimant abilities as opposed to inabilities, part of which focuses on the claimant’s bio- psychosocial factors. Assessors are given tools to break down the claimant’s pre-disability occupation into its key duties and to consider these in relation to a claimant’s functioning.
• Use of medical and investigative resources: This module considers how assessors can communicate most effectively with treating doctors, with a focus on asking the right questions, building rapport and returning the claimant to work. In doing so, assessors can appropriately gather information directly from a treating doctor, hospital or allied health provider and get the most out of an independent medical examination.
• Internet searching: The Internet is an important tool in claims assessment. This module identifies search techniques and information gathering from social media and/or other sites as part of the claims assessment process.
• Effective use of surveillance: This module, which is still under development, is a web-based interactive case management simulation, designed to get assessors thinking about the purpose of their investigations and understand how they can be used in the most effective manner.