Delays in surgery approvals and benefit confusion can stall recovery. Here’s how employers and carriers can take proactive steps to keep the process moving and support healing.
Transitional duty assignments often provide injured workers with structure, motivation, and a sense of momentum in their recovery. For Mohsen, the assignment has been a step in the right direction, but his experience also highlights key breakdowns that can slow progress and cause avoidable stress.
Despite being engaged in modified-duty work, Mohsen has been waiting more than four months for knee surgery authorization. At the same time, he’s uncertain whether his reduced hours will affect his health insurance. These kinds of delays and unclear communication are not uncommon, but they are avoidable. And they can have a real impact on a worker’s physical, emotional, and financial well-being.
When Systems Stall, So Does Recovery
Long waits for treatment and lack of clarity around benefits don’t just create frustration – they can delay healing, increase claims duration, and damage trust in the system. Fortunately, employers and insurance carriers can take several practical steps to prevent these issues before they begin.
Fou Ways to Strengthen the Claims Experience and Support Recovery
- Proactively Review Benefit Eligibility: If a modified-duty role results in fewer hours, it’s essential to assess how that reduction may affect the injured worker’s eligibility for health insurance or other benefits. Communicating changes early and offering options to maintain or bridge coverage can reduce confusion and stress.
- Streamline Medical Authorization Timelines: Surgery and treatment delays are a common and costly barrier to recovery. Carriers can tighten coordination with medical providers and set internal benchmarks to shorten approval timelines. Faster authorization means faster healing and quicker return to work.
- Provide Claim Navigation Support: Injured workers often struggle to understand where they are in the claims process, especially when major medical decisions are involved. Assigning a dedicated claims navigator or point of contact can provide much-needed clarity, answer questions, and reduce anxiety.
- Audit and Optimize Claims Processes: Regularly reviewing claims processes helps identify inefficiencies, particularly in areas like treatment approvals and benefit coordination. Even small improvements in these workflows can significantly improve the injured worker experience and reduce overall claim duration.
While communication is important, Mohsen’s experience reveals a deeper opportunity: operational improvement. A smoother, more transparent claims process isn’t just more humane; it’s more effective.
By investing in smarter systems and proactive communication, employers and carriers can help injured workers get the care they need, maintain their financial stability, and return to work with confidence. Healing happens faster when the system works with the workers, not against them.
