Predictive Analytics delivers on workers' compensation claims

When a worker is injured on the job, a missed warning sign about the severity of an injury is a missed opportunity to intervene with the right care at the critical moment. That missed opportunity can add days or even weeks to the worker’s recovery and time away from work, compounding the pain, worry and costs associated with a claim.

The portion of workers' compensation claims that goes to medical services has increased from roughly 40 percent in the early 1980s to nearly 60 percent in recent years¹ , according to the National Council on Compensation Insurance (NCCI).

To tackle that concerning trend, our Claims team collaborated with our Predictive Analytics team and challenged themselves to gain additional insight into how claims might develop even earlier in the claim’s trajectory. They succeeded.

Together, they created digital models that interact with a claim from the moment it’s filed until it is closed. Some examples of the benefits of our predictive analytics models include:

• Identifying claims that have the potential to develop into a “Tier 3” claim, allowing us to assign the claim to a Tier 3 claims professional even though it has yet to meet the Tier 3 criteria. Dr. Nina McIlree, Zurich’s Vice President for Medical Management, explains: “By having the claim handled at that level from the outset, we can promptly dedicate the most appropriate resources to the claim and reduce the number of claims professionals that the claimant works with.“
  
  
• Flagging claims that could potentially benefit from nurse case management. These claims are then assigned to a dedicated team of nurses who triage the claim. For these flagged cases, assigning a nurse early on in the treatment can produce significant benefits, including $6,000 to $26,000 in terms of cost mitigation, according to our claims monitoring, and the possibility of a faster, fuller recovery for the worker.

Our models are constantly running in the background of our claims files. As a file is updated, our claims professionals are sent a notification. One example would be notification of extended opioid use by a worker.

Timely notifications from our models help ensure case strategies and treatments can be reviewed and revised if necessary and as soon as possible.

The goal? It’s the same one our Claims teams continuously strive for: To provide the best possible outcome for the worker as well as our customer. Watch our video featuring Dr. Nina McIlree, Vice President of Medical Management at Zurich North America, to learn more.

1. Stahl, John. “Size matters: NCCI attributes medical costs trends to claim categories.” LexisNexis® Legal Newsroom: Workers Compensation Law. 4 November 2011.