Helping our customers find a healthy balance

By Ciaran Curley, Head of Claims Strategy, CommInsure

It’s well known that as an industry, we are facing demographic, economic and social trends that are constantly changing. Some of these are known and can be fairly predictable. With others, we just need to remain open to and show a willingness to respond with appropriate care and treatment, versus a “once size fits all” approach.

As a result, rehabilitation and how we determine what “successful rehabilitation” looks like needs to be looked at through a new, or perhaps broader, lens.

Rehabilitation in the claims process can come in many forms. Its legacy in life insurance has been in occupational or vocational rehabilitation where the goal has been to get members back to the workplace. This can be in the form of supporting them to return to their previous occupation, a new occupation or simply giving them job seeking skills such as helping them develop their CV.

We should be proud of this legacy because it has produced great results for many, but not all.

We now know an equally important rehabilitation goal is to get all our members back to their quality of life. Because in order to get our members back in their workplace, we need to help them with confidence and get them to re-engage back in the community by first getting them back to wellness.

It is this area – back to wellness – where we, as an industry, need to ensure we are evolving our products, care and support services. Yes, supporting our members in making a return to work is important but having rehabilitation goals that return a member to wellness is equally important, and perhaps an even more critical first step.

It’s in the care and treatment of mental health where our business, CommInsure, is seeing inspiring outcomes.

Every year an estimated four million Australians live with mental illness, disrupting wellbeing, personal relationships, careers and productivity. Almost half of all Australian adults will experience a mental health condition in their lifetime.

Mental health claims tend to be inherently more difficult to manage than claims for physical injuries or illness, partly because the symptoms and treatments for psychological illness can vary from one individual to another. Two individuals may share the same diagnosis but the manner in which it impacts one individual, the recovery period and appropriate treatment may differ significantly.

The role of early intervention on positive health outcomes is widely documented. Setting goals, plans and expectations during initial phases of illness provides focus, structure and direction during a time of uncertainty. Empowering individuals to make early decisions and set meaningful recovery goals collaboratively with their doctors and support networks significantly reduces disability duration.

At CommInsure we recently invested in a new ‘Back to Wellness’ program that supports members claiming for mental health to get back on their feet.

The program engages and empowers members in their own recovery within a collaborative and supportive claims framework. Its purpose is to reduce the impact of mental health and restore wellness in the lives of our members. During a pilot phase, capacity for work was re-established in more than 50% of Wellness program members. Since the program has been embedded as standard business practice, Wellness program members have continued to progress their recovery journeys and the program recently won the AFA/Plan for Life Risk Product Innovation award for 2016.

Income Protection is a very valuable safety net but, at the end of the day, it protects up to 75% of your income. Our collective goal should be to support members to return to work and earn 100% of their income. We can achieve this by supporting members to return to work at the optimal stage of their recovery and that’s a shared goal that should be supported by all stakeholders involved in a claims process:

For members, a Back to Wellness program makes them feel well supported and they state the removal of claim forms helps decrease stress.

For doctors, it is a more “humanising process” and reviewing Wellness Plans that track patient progress also help relieve some administrative burden.

For rehabilitation providers, they enjoy providing a holistic rehabilitation approach which members are more receptive to and it also improves communication and collaboration with doctors.

For case managers, the program provides a more complete understanding of the member’s overall circumstances, allowing for the development of more appropriate claims strategies.

The potential is significant and as an industry, we can build on the current wellness model to other conditions. We can track symptom change over time and measure change in disability severity as well as explore accessibility integrations including digital platforms and technology that interacts with the Wellness Tools.

At the end of the day, all of us in Claims teams across different organisations exist for a common purpose: to ensure we’re applying best practice recovery principles and optimising the member experience, facilitating faster recovery. Minimising the impact of mental health on the lives of members, their families and communities is a critical, and growing, component of that purpose.

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Important Information
This article was prepared by The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (CMLA) which is a wholly owned but non-guaranteed subsidiary of Commonwealth Bank of Australia ABN 48 123 123 124. The information is of a general nature only and should not be regarded as advice, financial or otherwise. CommInsure is a registered business name of CMLA.

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