1. From the outset, identify what you want to achieve.

Is your aim to help the person back to work? Or is your role to simply process the claim in an efficient and effective way for you and the claimant? Do you consider there is a need to rationalise treatment?

Is your aim to settle the claim, to work with the claimant to get to an endpoint where the claim is finalised?
Being clear on what you want to achieve will help streamline your approach.

2. What’s the state of the case file?

Have you inherited a mess? Is the file in order, with reports in one section, certificates in another, invoices separated? Is the information in date order? Do you have the case notes from other case managers?

It’s a tough gig to get a handle on a complex case if you don’t have a readable file. It may take a few hours to get the file in working order, but it’s vital to do so. It helps identify patterns, gaps in information, and may provide you with clues as to next steps in management. It’s also a great way to review the input of others.

3. Is the goal you have been set realistic?

If your aim is to help the worker return to work, is this practically achievable?

What resources will be required and will these resources be available? If you set out to achieve an unrealistic goal, what are the potential downsides?

As a medical practitioner, I see many patients who have been off work for some years and the claims process is seeking to return the person to work. The challenges associated with returning someone to work after they have been out of the workforce for many years are substantial. In a proportion of cases this may be possible.

But the amount of time and energy and support to achieve this is substantial. One needs excellent rehabilitation skills to help someone who has been out of the workforce for a long period. Is someone sufficiently skilled available to work with you? Will they be allowed sufficient flexibility in their approach? Will retraining be supported? Is there sufficient trust between the claims managers and the worker / claimant?

Will a cursory approach to return to work be a waste of money and further frustrate the claimant and their treaters? And how about you? Should you have a discussion with your manager and make the case for further resources, or another goal?

4. What does the claimant want?

Is the claimant frustrated and angry with the system, and; do they want to be left alone? Are they stable and feel the situation is fine as is? Are they keen to return to work but have been unsuccessful so far, and just need extra assistance? Are they despairing of the current situation, but with encouragement and motivation would consider look at getting back into the workforce?

If you are not working together, your chances of a good outcome go down dramatically. Are they ready for change? If not, what can be done to improve their readiness to change?

5. What level of trust exists between the claimant and the claims manager?

If your aim is simply to process the claim, you don't need a particularly strong relationship with the claimant.

But if your goal is a more challenging one, e.g. assisting someone to re-enter the workforce, you're going to need a substantial level of trust between you and the claimant.

How can you develop that trust?

Tips to develop trust include:

• Understand their position.
  Before you speak to the claimant, have a general sense of the claimant’s situation and concerns. What are their health issues and what's transpired in the claim so far? Have there been communication problems previously? Claimants who have had a number of case managers are often already frustrated.
  
  If you are going to work with them, acknowledge the problems at the outset. Let them know there have been many changeovers in staff, and your work may also change. You can let them know that despite these issues you are keen to work with them.
   
• Engage in active listening.
  Give the claimant the sense that you understand their circumstances and their needs. Ask, listen, ask more, repeat back what has been said, and tell them what you have understood.
   
• Do what you say, when you say you'll do it by.
  For example, if you say you going to call back within two days, do. As soon as you start making commitments in not keeping them, trust goes down. If you can't get back in touch with the answer you promised, send a quick text or phone the person to say you need more time, and provide an updated time when you will get back to them.
   
• Help the person with something.
  It might be something small, such as paying an outstanding bill, helping them get an early appointment, or providing them with a particular service. Once they start to get a sense you are asked to help them, you'll be on the path to a constructive relationship. Starting to help the person is one of the most effective ways of developing a relationship of trust.
   

Continue reading 8 steps for tackling a long-term case - Part 2.