Workers' compensation claim departments have long struggled to contain excessive costs — typically driven by a small minority of difficult cases. When the only way to prevent cases from spiraling out of control is early intervention, receiving accurate and relevant information quickly and easily is a vital part of the process — albeit an often difficult task.
Why claims escalate
The right data can tell you a lot. But with large case loads and numerous “hot issues” to handle each day, many adjusters find it next to impossible to dig through that information. Claims escalate because of many factors: unnecessary treatment, obesity, psychological issues, social circumstances, comorbidity, opioid medications, secondary gain, and fraud. Some of that information is hard to obtain, while other data may hide in medical records, PBM reports, bill review records, and the like. Thus, many cases — which were seemingly innocuous at the start — end up on a downward spiral.
Over the past year, emerging technologies and innovative tools have made the challenge of getting such data simpler than you might realize. We’ve just released a free white paper, Stop the Madness! How to Unleash the Full Power of Your Claims Data to Prevent Workers' Compensation Claims from Spiraling Out of Control — which takes an in-depth look at how to use your data to detect difficult claims before they go off course and manage them for the best outcome.
