Improve Claim Outcomes

TYPICAL CHALLENGES

Consider whether your current system has the power to provide:

straight-through processing you can trust to mitigate loss costs and fraud leakage while serving clients’ best interests.

automated benefit calculations for every indemnity benefit type.

historical view of a claim at any single point in time to aid in litigation.

With rising medical costs, the trend toward social inflation and nuclear verdicts, a continuously changing regulatory environment with potentially steep penalties, and a tight labor market where experience is at a premium, technology has become ever more critical to enabling faster, better decisions and response.

Analytic insight and decisioning capabilities — purpose-built for workers’ compensation claim handling — allow you to work more easily and closely with injured workers and employers to achieve the most positive outcomes for all stakeholders.

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THE SAPIENS' ADVANTAGE

Automated claims processing and historical workers’ compensation data enable intuitive case management and straight through processing at the outset, including multiple cases for:
subrogation, medical management, loss control, fraud and more.

An out-of-the-box benefit calculator provides calculations for every indemnity benefit type. The system converts the claim average wage to weekly, monthly, or annual amounts per jurisdictional rules. Specific to jurisdiction and benefit type, calculations consider items like:
average wage %, minimum/maximum benefit amounts, maximum total amounts, maximum time periods, statutory waiting periods, overlapping benefit periods, benefits that use post-injury earnings or earnings capacity, permanent functional impairment (PFI) awards.

View a claim from any single point in time using our full history at-a-glance.

Our functionality has been proven to achieve faster and more accurate claims handling.

BENEFITS

Instantaneously assign adjusters by credentials for claim type, jurisdiction, location, and language.

Automatically identify claims for straight-through processing while enabling faster, more efficient adjudication of complex claims based on insurer risk tolerance.

Get fast access to real-time data insights for better decision-making, including ODG’s risk score, return to work guidelines, cost modeling estimates, and treatment indexes.

Remove the need for mass addition of fields.

Eliminate integration with external products or the implementation of a complex customization.

Reduce implementation cost and delivery risk.

Achieve operational excellence to improve performance.