ClaimWise

ClaimWise provides a structured and systematic review of the open Lost Time claims from current and past policy years with the intent of getting cases closed.

We call the adjuster’s that handle your workers’ compensation insurance claims, in current and past years, and ask them pointed questions to gather information on the status of open Lost Time cases.

Our goal is to find intervention points to create an opportunity to move the claim forward toward resolution. We provide a report to the employer and/or insurance agency as to the current status of the claim and what may need to be done to resolve it.

Additionally, at renewal, underwriters may want updated information on large, open and closed Lost Time claims. That information will be in your file or we can obtain it expeditiously. Having knowledge and reports of your Lost Time cases will demonstrate to Underwriters that you are seriously monitoring claims activity.

If your Experience Modification Factor has erroneous data from changes in claim reserves, we can get that revised information to NCCI for adjustment and re-issue of the Mod. In addition, we can identify loss trends and recommend the appropriate loss control techniques to prevent future injuries.

We will apply case closing techniques to try to get the case resolved promptly, which will help keep your long-run cost lower for Workers’ Compensation insurance.

We will intervene in open lost time cases to get them closed promptly because:

  • the open cases may increase your Experience Modification Factor
  • the open cases may increase your insurance premium
  • the open cases may deter good insurance carriers from offering a quote

Mission:

Our Mission is to get your claims closed through aggressive management of the file and to reduce reserves with frequent and thorough monitoring with the adjuster.

Action:

We call the adjusters’ that handle the claims, in current and past years, and ask them pointed questions to gather information on the status of open Lost Time cases.

Goal:

Our goal is to find intervention points to create an opportunity to move the claim forward toward resolution. We provide a report to the employer or insurance agency as to the current status of the claim and what may needs to be done to resolve it.

Impact:

By closing claims fast the loss ratio (claims divided by premiums earned) is lowered. Underwriters use Loss Ratio to determine your premium pricing—lower is better.

If a claim is settled for less than is carried on the Experience Modification Worksheet we will notify NCCI to correct the erroneous data which may result in the lowering of the Mod.

Additionally, at renewal, underwriters may want updated information on large, open and closed Lost Time claims. That information will be in your file or we can obtain it expeditiously.

Having knowledge and reports of your Lost Time cases will demonstrate to Underwriters that you are seriously monitoring your claim activity.