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Workers’ Compensation Claims Solutions

Data-driven insights to improve workers’ comp claims

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Complex claims and compliance costs insurers

Workers’ compensation insurers are challenged with managing complex claims, rising claim severity, and stringent reporting obligations. And with many experienced claims handlers nearing retirement, the challenges become even more daunting.

Powerful analytics help conquer claims challenges

Verisk’s data-driven claims solutions empower workers’ comp insurers to mitigate risk, contain costs, streamline claims processing, verify appropriate medical treatment, and enable accurate compliance reporting.

Automating insights to transform workers’ compensation claims

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Discover how workers’ compensation data can provide valuable insights through advanced automation technology for improved results.

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Wcnavigator

Identify severity faster with predictive analytics

Detecting claim severity early can help you improve triage, contain costs, and enhance employee return-to-work timelines. Our solution leverages predictive analytics to accurately identify workers’ comp claim severity as early as day one.

  • Scores and re-scores claims daily as new information is received
  • Integrates prescription and medical data directly from your PBM and MBR providers
  • Accurately predicts 88 percent of high severity claims within first 30 days
Learn about wcNavigator
Speed Precision

Speed and precision at claim intake and investigation

Streamline claims processing and improve SIU referrals with powerful tools that leverage robust industry data and analytics to deliver critical insights early in the life of a claim.

Learn about ClaimSearch

Discover the latest workers’ comp claims insights

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New Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (Version 3.5) takes aim at non-submit and EBMSAs

Centers for Medicare and Medicaid Services (CMS) has released an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (Version 3.5, January 10, 2022).

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COVID-19 and Workers’ Compensation Revisited: Navigating the pandemic to understand what’s next

Last year we discussed ways the pandemic could impact workers’ compensation claims. Now, nearly a year later, we reflect on some of the answers to those questions.

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The COMP Act is reintroduced in the U.S. Senate

On 3/10/21, Senators Ben Cardin (D-MD) and Rob Portman (R-OH) introduced the Coordination of Medicare Payments and Workers’ Compensation Act (COMP Act) (S. 653) into…

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Starting March 27, 2021, CMS will use the 2018 CDC Life Table for WCMSAs

Starting 3/27/21, CMS has announced that it will use the new 2018 CDC Life Table to calculate adjusted life expectancies in Workers’ Compensation Medicare Set-Asides…

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Detect fraud in workers’ comp claims

Detect Fraud

Detect fraud in workers’ comp claims

Workers’ comp fraud is one of the fastest-growing types of insurance fraud. Fight it with our extensive suite of claims fraud solutions that leverages robust data and innovative technology.

  • Predictive analytics fueled by more than 1.5 billion claims
  • Medical provider fraud analytics that score more than 1.5 million providers
  • Advanced link analysis software that uncovers organized fraud activity

Streamline data reporting, improve compliance

Accurate, on-time compliance reporting

Wcprism

Accurate, on-time compliance reporting

Data accuracy and timely reporting are critical to EDI compliance, but varying reporting requirements make compliance challenging. Our leading solutions help you save time and improve workers’ comp reporting accuracy and timeliness.

  • Meet data collection organizer (DCO) requirements for aggregation and valuation of policy and claim data for the submission of unit statistical reports (USRs)
  • Consolidates medical bills into one data warehouse to manage compliance reporting for all DCOs
  • Meets requirements for aggregation and valuation of indemnity claim data for the submission of the indemnity data call to the DCOs

States: Capture workers’ comp data efficiently

Wccapture

States: Capture workers’ comp data efficiently

States seeking to initiate EDI reporting or transition to a new IAIABC release can get precise, cost-effective data intake for workers’ compensation claims and medical data through wcCapture™.

  • Helps collect FROI and SROI from insurers with greater efficiency
  • Gathers medical data needed to set fee schedules, identify fraud, and implement cost containment strategies

Actionable insights, better outcomes

Untapped Workers Comp

Learn how workers’ comp analytics helped improve EDI compliance at Liberty Mutual and for the Commonwealth of Virginia.

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Achieve full Medicare compliance, reduce exposure

Medicare Compliance

Achieve full Medicare compliance, reduce exposure

Whether you need to quickly and accurately identify and report Medicare recipients, dispute conditional payment liens, or allocate future medical costs, our solutions and services help you comply with CMS and avoid costly penalties by providing you with key information to:

  • Satisfy Section 111 reporting requirements
  • Automatically fulfill MAIS reporting obligations
  • Reduce conditional payments
  • Determine accurate workers’ comp Medicare Set-Asides

Verisk also provides additional claims reporting compliance solutions

Child Support Icon Child support intercept matching
Casualty Reporting Casualty reporting
Questionable Claims Questionable claims reporting
Ofac OFAC screening

Learn about Compliance Solutions >

Optimize claims resolution

Close complex claims faster

Medicare Future Allocations

Close complex claims faster

Open claims costing your organization? Our team of medical and legal professionals can remove obstacles to closing claims with fast settlement approvals.

  • Coordinated settlement conferences for large-scale claims resolution
  • Expedited Medicare Set-Asides or conditional payments preparation

Insights to guide your litigation strategy

Legal Analytics

Insights to guide your litigation strategy

Leverage an easy, automated solution to track and apply case law to incoming claims. Our solution scores complex coverage issues, provides insights on differing treatment of issues by jurisdiction and, based on court opinions, evaluates the impact of case decisions on policy language.

  • 150,000 data points to guide litigation strategy and reserve allocation
  • Outcome of case law empowers you to evaluate your level of exposure in your book of business

Facilitate fast and fair claims resolution

Liability Navigator

Facilitate fast and fair claims resolution

Improve settlement decisions and negotiation strategies with a claim-matching solution that analyzes a claim’s attributes against your company’s historical data and provides guidance on settlement amounts and likely length of time to settle.

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Other Ways to Connect

We are available Monday through Friday, 7 a.m. — 9 p.m. US Eastern Time:

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  • Main Toll-Free: 1-800-888-4476

  • Global Toll-Free: International Access code, then 800 48977489
    When calling from the UK, please dial 00 800 4897 7489