Social insurance schemes can protect workers and their dependents in the case of occupational injuries and diseases. Such schemes ensure that injured workers have access to the health and rehabilitation services they need, and that they or their survivors promptly receive cash benefits to compensate for loss of income.
openIMIS helps to manage information flows related to employment injury insurance processes by bringing together employee, employer, healthcare provider and payer data into a single platform. Its simple accident reporting system and efficient claims procedures can help to ensure that workers or their survivors receive benefits promptly.
Business processes
openIMIS supports the following business processes for employment injury insurance:
Enrolment
Accident reporting
Health service utilisation
Health service claims generation and submission
Claims review process
Processing and payment of claims
Benefits
For employees, openIMIS simplifies enrolment procedures, makes it easy to verify one’s coverage status at point of care and ensures prompt receipt of benefits in case of injury. For employers it provides a one-stop solution for managing both enrolment and accident reporting, with seamless links to information from hospitals about treatment and rehabilitation. For health facilities, it streamlines the processes associated with a health financing scheme and makes it easy for them to receive reimbursements. For scheme operators it reduces operational costs, allows for better monitoring and analysis of the scheme’s overall performance, and enables information to be shared between different health and social protection schemes.
Example workflow
Current implementations
Further information
Visit the wiki page or download the factsheet for this openIMIS use case: