As psychological injury claims present complex challenges, with case managers having to navigate the delicate balance between support and investigation, the need for innovative solutions has never been more pressing. 

QBE Insurance’s collaboration with the University of Newcastle's Centre for Rehab Innovations (CRI) is an example of taking an innovative approach.

Their project had 2 objectives: improving claims management processes while ensuring robust support for staff wellbeing — including by protecting their teams from the vicarious trauma that can arise from managing psychological claims.

The approach

QBE acknowledged that while extensive research and resources exist in the field, the real challenge lay in implementing best practices within the fast-paced claims environment. 

Despite having launched various initiatives to enhance capabilities and processes, they recognised the need for an independent assessment of their operating model.

Professor Rohan Walker, Co-Director of CRI, led the initiative, working closely with Dr. Elizabeth Ditton, CRI's senior clinical psychologist, and the broader multidisciplinary team at CRI — which includes business experts, healthcare professionals and data analysts. The team:

• conducted a thorough 6-month review of QBE's operating environment and claims management processes
• analysed thousands of claims and best practice literature, and 
• conducted a gap assessment of QBE's service delivery across the entire claims lifecycle.

Results of the literature review 

The review found that QBE's existing psychological injury management processes largely aligned with industry best practices. However, several crucial factors emerged from the literature analysis:

The importance of building high-quality relationships 

The research emphasised the critical importance of building high-quality relationships not only between claims managers and injured workers but also with medical and allied health service providers. These interconnected relationships were identified as key drivers of positive outcomes.

Biopsychosocial screening 

The literature highlighted the fundamental role of biopsychosocial screening and early risk factor identification. 

Fairness

Another critical finding was the significance of procedural justice and fairness in claims management. Injured workers needed confidence that they were entering an unbiased system, even when claim outcomes might not be favourable. This created a delicate balance between setting realistic expectations at the outset while maintaining supportive, transparent processes throughout the claim journey.

Tension between process-driven approaches and humanistic care

While psychological injury claims management evolved from actuarial processes with their inherent need for progression, the research emphasised the importance of keeping human elements central to the claims management process. 

What did the data analysis reveal?

Analysis of thousands of QBE's Treasury Managed Fund claims data confirmed several expected patterns in psychological injury claims and demonstrated:

• the importance of employers prioritising reducing notification delays for psychological injuries and minimising delays in liability determination
• that liability investigations can negatively impact injured workers' perception of procedural fairness
• the importance of early discussions about RTW expectations, including whether returning to the same employer is feasible. 
• that access to psychological treatment within the first 6 to 12 weeks serves as a strong predictor of positive outcomes.

Systemic challenges

The study also identified several barriers to effective claims management: 

• High caseloads and extensive quality assurance requirements raised questions about whether these processes genuinely improved outcomes for injured workers. 
• The competitive labour market presented challenges in recruiting and retaining high-quality claims managers with the right capabilities.
• Stakeholder collaboration emerged as another challenge, particularly coordinating with medical professionals who often operate with different priorities and timelines. 
• The limited availability of psychological services was identified as a major impediment to early intervention, raising questions about service access and remuneration models.

The cumulative effect of these pressures, including the responsibilities of regulatory reporting, often left claims managers feeling they lacked control over claims progression, potentially leading to frustration, stress and burnout symptoms.

How did QBE fare against these findings?

The research team mapped best practices against QBE's existing claims processes to identify both areas of alignment and opportunities for enhancement. Rather than recommending wholesale changes, they identified strategic improvements that could build on QBE's already robust claims management framework to enhance RTW outcomes.

A key finding was that improving claims management required more than just enhancing case manager capabilities. While the interaction between claims managers and injured workers remains central to the process, these interactions are influenced by numerous business processes across the organisation. Success requires a whole-of-business approach, recognising how various organisational processes converge to shape the environment in which claims managers operate.

QBE’s response

QBE is implementing a comprehensive, phased response to the report's findings, focusing on initiatives that complement each other rather than isolated solutions.

They are enhancing caseload management by refining how psychological claims are introduced to new staff and implementing technology solutions to free up case managers for complex cases. 

The shift to hybrid working has led to new protocols for managing high-risk claims remotely, including enhanced training and regular staff check-ins.

Improvements to data architecture will enable better risk screening and early intervention strategies, particularly for physical injury claims that may develop psychological components.

The immediate focus is on existing initiatives and staff training, while technology solutions are planned for 2026 and beyond. A dedicated program manager will oversee the process, with ongoing support from the University of Newcastle.

The final word

This project represents a significant shift from reactive to proactive psychological injury management, emphasising the importance of supporting both injured workers and claims management staff. 

As psychological claims continue to rise in complexity and number, this collaborative approach between industry and academia may provide a model for sustainable improvement in workers' compensation outcomes.

Acknowledgement

This article was based on a presentation given at the 2024 PIEF National Conference & Awards by Jackie Costelloe (QBE) and Prof Rohan Walker (Centre for Rehab Innovations). RTWMatters is grateful to PIEF for allowing us to share content from the conference.