The Map
Employer
EmployeeTreatment/
Rehabilitation
Provider
Best Practice RTW (Based on the Better@Work Philosophy)
A coordinated and simple approach between all
parties is essential to facilitate early RTW
ACC
Resources and templates to assist employers with IM.
Tailored IM support via Injury Management
Consultants
ACC manages claims from registration through to exit.
Employer contact is variable
and with multiple ACC
contacts.
A variety of services are available where an external
coordinator works with all
parties to achieve early
RTW (eg Stay at Work,
Better@Work and Fit for
Work trials)
Generally none. Some employers have a dedicated
case manager but this is
done on an arbitrary/ad hoc
basis
Larger employers who meet specific criteria can access
the Accredited Employer Programme
Temporary Earthquake Employer Service
Online materials for employer self-management:
alternative duties for specific industry types
factsheets/ guides
value statement re benefits of injury
management
Employer 0800 number/email for basic enquiries
Employer-Centric Case Management Model
Online information (eg information on entitlements)
Management of non-work injuries
Dedicated key employer contact under Employer-
Centric Case Management
model
Claims briefing/ progress report
Targeted education via workshops
Specialist email and phone support via 0800 number/
email
Tailored IM support via IMCs, for example:
expert advice
training/ support for in-house RTW coordinator
gap analysis and assistance towards
moving to risk-sharing
options
Incentives and rewards/ sanctions and penalties
Cost-benefit tools to calculate return on
investment for employers
Additional online resources
Absenteeism and wellbeing management services
On-site case management
Self-management options
Key Person Cover
Roll out Employer-Centric Case Management Model
for all Work and Earner
Account injuries
Risk-sharing options
STANDARD CUSTOMER
(default product)
STRATEGIC/ HIGH-VALUE/PRIORITY
CUSTOMER
(+add-ons)
STANDARD CUSTOMER
(default product)
STRATEGIC/ HIGH-VALUE/PRIORITY
CUSTOMER
(+add-ons)
INJURY MANAGEMENT (IM) CLAIMS MANAGEMENT (CM)
CU
RR
EN
T S
TA
TE
PR
OP
OS
ED
FO
R T
RIA
L
(fro
m 1
Oct 2011)
AD
D-O
NS
FO
R F
UTU
RE
CO
NS
IDE
RA
TIO
N
(out of sc
ope)
Consider upgrading products and services to
meet market needs
Proposed Employer-Centric Suite of Services
Proposed Employer-Centric Claims Management Model for Trial from
October 2011
Key Risks
Risks for the Trial
The approach will not work if:
o ACC is unable to match employers to claims
o there is not a culture change in ACC to see the employer as
the customer (from a claims
management perspective).
The approach will be less successful if:
o ACCs customers are mostly low injury volume employers
o the value proposition (financial value of these products) for
employers is not understood or
articulated.
ACCIS will not be operational so there will not be a system to
match products to employers.
There will be limited skills/capability/capacity of IPS staff to
deliver IMC services and products
as a result of the restructure. It will also take time to
develop staff in new roles due to the scale
of change under the restructure.
Short timeframes of the trial may limit ACCs ability to
effectively test trial products and services.
Risks for Future Development of Service
The service needs to fit with product development for expanded
risk-sharing options for small/
medium employers and an expanded AEP (IPS).
There are a number of barriers for more radical options (eg
legislation, systems, resourcing, need for more research and
direction). In addition, these options will need to be further
developed by IPS (ie flowing out of the IPS Customer Project
& overarching blueprint).
If the definition for customer segments (eg high-value customer)
is not fit-for-purpose across
both IPS and Claims Management there will be inconsistencies in
service delivery, which may
impact on Scheme costs and ACCs ability to meet customer
needs.
Employers may not want to pay for add-ons (but may be interested
in levy discounts). Product
pricing must be right.
Potential limitations for ACC if the Work Account is opened up
for choice of insurer (eg statutory limits on products and services
that can be offered).
- Vocational Services Review
- GP Certification Project
Claims
administrator/
coordinator
team
(centralised)
Key Employer
Contacts
(grouped by
industry type)
Relationship
Manager
Employer has injured employee*
*Not med-fee only
Key Employer Contact (KEC)
Employer claims portfolio management:
Respond to queries and channel as appropriate (eg
referral to online tools)
Build/maintain relationship with employer(s)
Up sell to add-on services/products
Claims Management -
o Undertake risk assessment
o Gather relevant information \
o Stream to appropriate management party (including
de-escalation of claim to claims coordinator if
required)
o Complete action plan
o Set up relevant entitlements (eg weekly
compensation) and services (eg Stay at Work) in a
timely manner
o Employer liaison (eg support for employers to engage
in RTW process)
o Liaise with Prevention and Management Consultants,
and Relationship Managers as appropriate
o Provide regular reporting to high-priority employers re
claims experience (eg claims dashboard)
Key skills:
Industry Knowledge
Rehabilitation knowledge
Claims Management experience
Strong telephony skills
Custo
mer
valu
e to A
CC
Customer need/ willingness to pay
CUSTOMER SEGMENTATION (indicative)
Standard CustomerStrategic/ High-value/
Priority Customer
Work injury claim is
streamed to relevant
industry group
(non-work injuries =
status quo)
Work/non-work injury
claim is streamed to
dedicated Key
Employer Contact
within relevant
industry group
Claims Coordinator/
Administrator
Claims and Administrative
support:
General claims
administration (eg manage
purchase orders, invoice
discrepancies, payment
information gathering etc)
Provide other assistance
as delegated by KEC
including management of
simple claims if required
Relationship Manager
Key business relationship
for high-value employers:
Will need to link in closely
with KEC to ensure
coordinated services/
communication with
employer
High
Low
High
Standard Customer
Access to standard/ core services
Strategic/ High Value/ Priority Customer
Access to add-ons
Small to Medium employer or Self-employed
Large employer or Accredited employer who is capable and willing
to support RTW
Large employer who does not have capability to support RTW
Medium employer who is capable and willing to support RTW and a
key influencer of other employers
IPS Customer
Project to
inform
segmentation
(Aug-Sep 11)
ACC will trial standard and add-on products and services with
pre-selected
medium to large employers (nationally), and standard products
with small to
medium employers within 2 pre-selected industries
(regionally).
