Non-profit mental health group SuperFriend has released an evidence-based best-practice framework for superannuation funds and the group insurers of those funds to improve the experiences for everyone involved in mental health insurance claims, particularly the Person on Claim (PoC).
The document, Taking Action: A best practice framework for the management of psychological claims, is the end product of an extensive process undertaken by SuperFriend with the insurance and super industries, the Superannuation Complaints Tribunal, the National Mental health Commission, and other related individual researchers in the psychology field. The report takes a largely theoretical discussion about mental health and brings practical actions to the table – much needed, despite greater understanding than ever about mental health and emotional wellness, and what it takes to recover from and be supported during these afflictions.
In 2014 SuperFriend released the Super Mental Illness National Data Project, a study revealing that around 10 per cent of all insurance claims within superannuation were due to mental illness and suicide. This is not an insignificant figure when we are take into account the huge variety of non-psychological illness and disease we face in Australia. What this indicates is the growing awareness of mental health outcomes, and its reach, with the risk insurance industry in an interesting position to help, via superannuation funds. Providing better experiences in a vulnerable time isn't an extra expense, but a necessary support act.
The Taking Action framework offers ideas for providing better mental health support for people on claim, which is by its very nature a complicated time mentally and emotionally – being sick, disabled or terminally ill, or evaluating someone who is, doesn’t come with a guidebook, and the industry has needed practical tools. This document is timely.
The expansive framework offered has eight action areas, with the first being Developing the Management Practices for Psychological Claims. The other seven actions will be released over time, but address technology, product design, and encouraging employers to keep employees at work, or get people back to work faster.
The other main actions outlined in the framework include optimising claims management teams, bringing evidence to the treatment and rehabilitation of clients, promoting effective decision-making backed by analysis and automation, providing tailored support for the person claiming, ensuring products are fit for the task, and recording progress.
The actions are guides only, and not to be taken verbatim – every case will be different and requires individual evaluation, as is the nature of human emotion and motivations.
The nature of psychological claims
The framework document discusses the fact that psychological claims are usually far more complex, time-consuming and expensive to undertake than injuries or other illnesses, since every person will have a unique set of experiences that characterise their claim, which is not so with other, more straightforward cases.
A diagnosis of depression, for example, can look very different on two people, and the time it takes for each to recover, the treatments that work best, and other important treatment variables must be understood to be variable and different for each person involved. While a broken leg almost always takes around the same amount of time and treatment to heal, our emotions and mental health are extremely variable and complex, since the cause or triggers can be mysterious. Relapses can be frequent, since life has a way of ensuring nothing runs smoothly for too long at a stretch.
The mental and emotional repercussions of a physical injury or illness must also be taken into account, with a secondary claim possibly developing after the primary claim, inhibiting the person from getting back to work.
It can be easy to judge a book by its cover and miss the boat of the great unseen that lies inside each of minds, a risk insurers must be cautious not to underestimate, and an element that this framework carefully explains. Making assumptions about things we cannot see is dangerous.
Mental illness in Australia
The backdrop for Taking Action is primarily that psychological health problems are increasing in incidence in Australia, with 45 per cent of those aged 18-65 experiencing a psychological health disorder in their lifetime. This costs, among many other things, money.
Claims rates are increasing for mental health-related disorders, particularly for total and permanent disability (TPD) and income protection, but costs extend to employers in sick leave, overwork, and compensation claims.
The outcomes we seek
Better claims experiences are the desired outcome, with return to work being a major driver, since it is well-observed that people with something to wake up for every day are happier and healthier than those who do not. Having a poor claims experience whilst having a poor life experience is bad news for recovery, and it seems, this is one area the industry could improve at.