5 Reasons Workers' Compensation Adjusters Need ISO ClaimSearch

By Carlos Martins  |  February 11, 2014

ISO ClaimSearch® has helped property/casualty claims departments streamline claims handling, identify suspicious activity, and comply with various state regulations for more than 40 years. For the workers' compensation community, the platform has been an important resource for reviewing claim histories and informing adjuster decisions. For those reasons and others, all 28 state workers' compensation funds in the United States are members ISO ClaimSearch.

Why do they do it? Here are the five most common reasons:

1. Claim history: ISO ClaimSearch provides a full view of the loss history of a claimant, enabling adjusters to identify preexisting or subsequent injury or disability from auto and general liability losses. Adjusters can confirm prior or subsequent losses with overlapping injuries or disabilities, which can support termination of benefits on an existing case where appropriate.

2. Provider history: Adjusters can access medical provider details through ISO ClaimSearch, potentially opening new investigative avenues for preexisting conditions, interceding root causes, and abuses. Investigators can enhance those capabilities with ISO MedSentry, our new property/casualty medical fraud platform.

3. Improved negotiation: With ISO ClaimSearch, adjusters can identify other losses with related disabilities, leading to opportunities to negotiate offsets on workers' compensation settlements. And wcNavigator® provides predictive analytics capabilities in this area to identify high-risk claims.

4. Malingerer identification: You can use ISO ClaimSearch data to mitigate the risk of a questionable perpetual disability case moving to a new insurer upon termination of benefits. Indicators of this common problem, caused by a claimant seeking to extend his or her benefits, can potentially be identified through ISO ClaimSearch match reports. Secondary reports developed from Social Security numbers, social networks, and vehicle location reports have also proven valuable in fighting false allegations of disability.

5. Fraud indicators: With more than 900 million claim records (and 34.9 million matches for workers' compensation), ISO ClaimSearch is uniquely equipped to help workers' compensation adjusters unearth indicators of organized fraud, unrelated disability originating from an uncovered incident, and cases where the claimant is currently working while on disability.

Carlos Martins

Carlos Martins, SCLA is Vice President and General Manager of ISO ClaimSearch Solutions. Carlos leads the operations of ISO ClaimSearch®, the property/casualty industry’s premier and only “all claims” database with over 1.2 billion claim records and market participation of more than 90 percent of the property/casualty insurance industry. Carlos is also responsible for the surrounding ecosystem of integrated solutions for ISO ClaimSearch which includes claim scoring, predictive analytics, third-party data, and visualization tools. Carlos brings to this role – and all ISO ClaimSearch participants – more than 30 years of experience in the property/casualty industry, where he has held a wide range of claims and technology roles. He is based in Jersey City, New Jersey and can be reached via email cmartins@iso.com or 201-469-3103.