Using Analytics to Achieve Better Claim Results

August 31, 2021

4 INDICATORS USED
IN PREDICTIVE ANALYTICS

Identifying and managing key predictors can help a company mitigate claim exposures. By collecting specific data points throughout the life of the claim, you can apply predictive analytics to anticipate the direction and ultimate exposure of claims. Following are indicators that can be used in predictive analytics to help evaluate and mitigate potential losses.

1. Social-Psychological Indicators are those risk factors an employee has that may impact the outcome of an injury. Social-Psychological indicators encompass language barriers, housing and transportation issues, lack of access to a clean environment, or lack of supportive care in the household.  Knowing the barriers an employee may be facing, allows carriers and or employers to provide assistance in bridging the care gap.  Ensuring an individual is best prepared to recover has been proven to shorten the duration of the loss and increase the likelihood of the employee returning to work.  

2. Co-Morbidities encompass underlying conditions an employee may have that could impact their ability to recover from an injury.  Understanding the impact of an underlying condition on an injury provides insight into the recovery process.  For example, knowing you have an obese employee and offering a weight loss program for a knee injury can help improve the individuals’ injury outcome.  While the opportunity to use this information to affect the outcomes is significantly impeded in a liability claim, having knowledge of co-morbidities still provides opportunities.  When evaluating a liability matter with a known co-morbidity the adjuster can look to an early resolution, possible alternative injury sources, or even understand whether a Medicare lien could be in play. 

3. Medical Networks or Providers can provide indicators to outcomes.  Insurance carriers have captured information on providers whose consistent outcomes are less likely to have or need subsequent repeat treatment.  There is a gap in the possible information that can be obtained as a significant number of providers fall short of having these resources. Again, this area of opportunity historically has been incorporated on the workers’ compensation side, while on the liability side understanding the providers can be a guide to identifying the claim for early resolution.  

4. Legal Venue and Litigator Information will tell a seasoned defense counsel and claim professional what obstacles and challenges they will be facing as they look towards liability, exposures, and jury selections.  The costs and challenges in bringing a file through trial and appeal (when the prediction is the venue may warrant the same) need to be evaluated early in litigation process.  Understanding all aspects of the litigation will quickly bring to light claims ripe for alternative dispute resolution and/or settlement.

Utilizing predictive analytics places risk managers in a position to secure better claim outcomes, reduce loss costs, and create a competitive advantage to their peers.

Our claims advisors can be a resource to you for ways to mitigate or manage your claims, contact us.