Controlling claims costs: The spirit of co-operation

cooperation

With higher settlements and as claims costs rise, Bob Rabbitts praises insurers, claimant and defendant lawyers, and rehabilitation providers, for putting their differences aside to work together to provide consensus.

Working together to achieve consensus usually results in a better outcome than conflict — and this is at the heart of what the Bodily Injury Claims Management Association seeks to achieve. Certainly for insurers, the aim is also for improved knowledge to allow them to manage claims costs more efficiently.

Many motorists will already have seen a hike in their premiums linked to rising claims costs. Likewise, employers' and public liability claims costs have also been increasing. Actuary EMB has said the cost of claims for personal injury are rising at around 10% a year.

Higher settlements, an increase in more costly periodic payment orders and the need for insurers to pay for prompt physiotherapy — as well as other rehabilitation measures — privately are all having an impact. Of course, fraud is also an issue, but this is less of a factor in many of the claims Bicma is focused on, since they tend to relate to more serious injuries, namely those that are described as catastrophic and mid-range.

Recent progress
Although the actual costs have risen, there has also been progress in recent years. Almost all will agree that rehabilitation should come first. Finding the best outcome for the claimant is in most cases being agreed at an early stage.

Bicma brings together insurers and claimant and defendant lawyers, along with specialists such as rehabilitation providers and other experts — there is even a judge among the members. It also works with other associations such as the UK Rehabilitation Council, Case Management Society UK, the Association of Personal Injury Lawyers and the Forum of Insurance Lawyers.

There is no talking shop — no one has time for chit-chat — and it is not forgotten that those meeting may well be adversaries in their day-to-day job. As a result, there is an overwhelming desire to try and break down barriers and distrust. The Bicma cannot impose recommendations, but produces codes and best practice guides and, from experience, these are being acted on, as is evidenced by the improved care being made available to claimants.

Bicma's Rehabilitation Code or other negotiated agreements allow for prompt, often independent assessment. The claimant's needs are met quickly and, where appropriate, they can return to work and regain their independence, with the insurer paying a controlled sum of damages — typically far less than where proceedings have been protracted and litigious.

Clearly, there are often going to be disagreements between parties but there is also a lot of common ground. Currently, two working parties have been set up by Bicma to look specifically at brain injury claims and whiplash, with the intention of both improving outcomes and reducing costs.

In terms of brain injury, the focus is to improve knowledge. This is an area where diagnostics can be difficult — someone may outwardly appear well, but could have problems such as memory loss or other symptoms, which are the result of an injury. While not medical experts, Bicma is working on producing a guide that will provide information to help practitioners on both sides identify early signs and ensure that independent experts are instructed as soon as possible.

Meanwhile, whiplash claims are a perennial problem for insurers. Notably, there are some 400 000 new insurance claims each year — the numbers have doubled over the past five years — but road accidents have declined slightly. It is evident that better assessment is needed and Bicma is again working on a guide that will help identify who will benefit from treatment.

Currently, some argue that almost everyone should be provided with rehabilitation for whiplash, even though the majority of patients will make a full natural recovery in a short period of time. It is therefore important to be able to spot those who genuinely need physiotherapy treatment and avoid paying out for those who do not need it.

Both of these working parties will be developing a list of indicators, using the latest medical evidence from a range of sources to develop a consistent approach across the market.

Still frustrations
Although Bicma is doing good work, it would be wrong to say there are no frustrations for insurers. While there is greater determination to put the claimant's needs first, there are still too many incidents where there has been unnecessary stalling on both sides and where claimant lawyers have been slow to provide information.

There are also different approaches from insurers. At Allianz, having an internal rehabilitation team has proved enormously helpful when organising both fast and high quality treatment. But this is not common and there are instances when rehabilitation has not always been fit for purpose and case management has been patchy.

Moving forward, insurers and lawyers should spend time working on ways to boost their claims processes and to ensure that rehabilitation, and the claimant's welfare, are top of the agenda. The more co-operation there is, the better the results for everyone.

Bob Rabbitts is the president of the Bodily Injury Claims Management Association and technical claims manager for Allianz

Background to BICMA
The Bodily Injury Claims Management Association began in 1985, when a committee was formed to advise rehabilitation provider Rehab UK. At that time, rehabilitation was not the 'given' it generally is now but some insurers realised that, since they were going to have to start paying for treatment far more widely in the future, the more knowledgeable they were, the better.

An advisory committee was set up, chaired by Norman Cottington, then of Highway Motor Policies. Since then, meetings are held regularly, along with workshops and seminars. In addition, a number of advances have been made and initiatives launched through Bicma. These include:
• A register of solicitors and insurers that support the Rehabilitation Code.
• The Practitioner's Guide to supplement the Code of Best Practice.
• The creation of the Case Management Society of the UK.
• A model agreement for those wishing to work more effectively within the code.
• An employers' guide for risk and line managers.
• A generic set of standards for rehabilitation providers and a register of those meeting these.
• A scheme, established with the National Mediation Council, for resolving rehabilitation-related issues.

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