A Victorian Auditor General's report on claims management by the Victorian WorkCover Authority (VWA) finds that the VWA does not achieve satisfactory outcomes for injured workers.

The VWA administers the scheme through six authorised private agents. The agents manage claims and serve employers and workers according to guidelines set by the VWA.

Revised in 2002 the VWA's claims management model aimed at 'improving return to work outcomes' and 'achieving cost effective claims management'. The Auditor General's report finds that a significant reduction in projected liabilities of the scheme has been achieved. The model has been effective in the management of high risk claims, maximising the financial sustainability of the scheme. However, it also states that 'There is scope for the VWA to improve agents' case management practices in order to better maximise outcomes for injured workers.'

'Scope for improvement' doesn't sound like the end of the world, but commenting on the report a senior officer of the VWA privately suggests that the consensus view within the VWA of the agents' performance regarding return to work is that it is simply "bad." "They don't get it."

Apparently, while succeeding with a model that has cut costs and improved management of high risk claims, the agents stumble badly when it comes to dealing with the people side of managing claims. But, is it sensible to expect that a management model that is firmly focused on the bottom line should also be good at interpersonal relationships that satisfy the needs of claimants, who have diverse and different agendas that arise out of personally traumatic experience? Is it the agents who are the problem, or the system they are stuck with?

The common criticism we hear of the Victorian claims management model is that it is 'process driven'. A box-ticking exercise rather than a supportive experience. Claimants say that the system reduces them to a number.

The lack of positive feeling in the system is perhaps one reason why there is such a high turnover among claims staff. A full 32% of case managers employed by Agents do not have the required minimum two years claims management experience. The Auditor's report recommends identifying industry roles, specialisations and career paths to improve staff retention and the introduction of a mandatory standard training framework for case management. Improved training and an established career path with identifiable job satisfaction is long overdue.

The report also recommends an 'Annual Performance Adjustment' (APA) that directly rewards or penalises agents on their claims management performance as a means to improve outcomes for claimants. The APA approach to claims management seeks to apply a bottom line KPI to a bottom line management model in order to improve performance in the context of relationships.

Sounds screwy to me.

The key elements to successful return to work are regular communication, positive relationships and solid partnerships. Being 'a paid friend' just doesn't ring true in this mix.

There are a number of good recommendations in the Auditor General's report that have already been accepted by the VWA. Stuff that deals with improving the engagement of medical practitioners, reviewing stakeholder communication, identifying risk, strengthening case management planning and other matters in this report. Find the full report here.

Will churn in case manager jobs in Australian insurers and agents lessen while the role continues to be 'bad cop'? If the high staff turnover is to be stopped, claims managers need to be given a good reason to stay. Creating a well trained professional group who enjoy appropriate work conditions and the daily satisfaction of helping people is the way to go. Until case managers are able to develop positive relationships with claimants rather than tick boxes in what is essentially a regulatory role, not much is likely to change.

It's pretty simple really. There is a high turnover in the claims manager role because the job sucks. People come into it wanting to help others but very quickly learn that the system has set them up to be the squishy bit in between what people feel they need and what the system really offers.

It's the difference between creating opportunities for claimants whom we trust to contribute the unknowable and therefore priceless work they have not yet done to society, or making sure they don't get away with anything because the system is biased towards protecting the bottom line and hence starts from a position of distrust.