We provide independent and impartial claims inspection services for disability insurers.
Our health claims consultants, who have a nursing or occupational therapy background, visit claimants with a particular objective of helping with rehabilitation services as well as assisting in the claims process
Our immediate needs assessment will be of assistance to the claimant, their insurer and the employer. As well as giving help in the basic claims process (for example, how to complete a claim form) the process will also help to establish:
· The validity and probable duration of incapacity
· Whether recovery and return to work will benefit from immediate help or if the
claimant is likely to need assistance with rehabilitation following treatment
· An understanding of the claimant’s full personal circumstances
Our consultants are trained to look for the biopsychosocial pointers to non-medical factors that might be barriers to a return to work. As part of this discipline, they will undertake:
· An Engagement/Motivation to Return to Work analysis – a diagnostic process
which generates an immediate initial assessment of the claimant’s declared
engagement with their employment, presented garphically and compared with
normative data; and
· A Field Force Framework – a comprehensive graphical analysis of the key
driving and hindering factors of the situation perceived to be the most influential
in terms of outcome
We also conduct Claim Review Visits since we know that a claimant’s circumstances can and often will change during the duration of an absence.
One of the Health Claims Consultants’ main objectives is to try and establish the true physical functioning levels and psychological status. It is particularly important that these enquiries are carried out in an unobtrusive and non-invasive way. This can accomplished by observation and discreetly encouraging the claimant to carry out various simple tasks which will involve mobilising, bending, lifting, sitting, manual dexterity, the use of relevant questionnaires if appropriate, assessing cognitive functioning and the use of non-direct and direct questioning.
Consultant visits can be particularly effective for self-reported disabilities such as anxiety state, depression, chronic fatigue and where the disability is said to be stress related.
Clients are provided with a comprehensive report on the findings of the visit along with a set of recommendations if required.