The use of business intelligence can produce enhanced workflows and improved results for case and claims management. Informed proactive decisionmaking helps to drive results that are meaningful to policyholders, clients and shareholders. This reality is particularly true in the area of workers compensation where increases in claim volume and exposure severity seem virtually endless. Poor loss runs, claim settlements and WC decisions all contribute to the frustration and economic damage sustained by employers inundated by this exposure.
To manage workers compensation defense optimally, professionals must be equipped with accurate, timely, and highly organized claimant data.
While counsel, adjuster and the corporate risk manager all work in separate silos, they also work within the same umbrella of issues that make up the workers compensation workflow. Consequently, each of theses professionals need to understand and value the core workers compensation tasks/workflows that drive ultimate outcomes. These workflows include:
1. Factual investigation for claim details, coverage review, and possible fraud detection
2. Medical management with healthcare professionals, case managers sand experts
3. Return to Work initiatives
4. Permanency evaluations and case resolutions
The importance of using data in workers compensation management is generally well understood by industry professionals. Because data comes from many different sources and in many different formats, it needs to be expertly managed. Examples of the types and sources of workers compensation data germane to case/claims management include:
1. Incident reports
2. First Report of Injury
3. Manager reports
4. Witness statements
5. Healthcare reports including doctor, hospital, physical therapy, nurse case manager reports
6. Vocational assessments
7. Expert reports
The utility of data is constantly evolving. Historically, value and learning was acquired through the manual process of acquiring data by reviewing a static report. This process of locate, read, search and then extract information was time consuming and burdensome. Today, data is put to work by industry professionals with expert technology systems. This data management easily translates into gained efficiencies in staffing and work product and improved results.