Optimize Resources & Improve Results

What is Claim Scoring?

This accurate and objective measurement of disability or workers compensation claims enables the optimizing of all claim management resources. Optimizing of resources improves results, saves money, and enables an ongoing focus on pro-active claim management.

Claim scoring uses advanced pattern detection technology to provide a numeric [1-10] measurement of the likelihood of return to work of a disability claim. Scores rise with likelihood of return to work – a score of ‘1’ indicates a 5% chance of return to work, ‘2’ indicates 15%, and so on.

Does Scoring Really Work?

Yes. Your model is developed from patterns detected in your own claims history. Advanced tools comb through your data to identify complex relationships in claim characteristics.

Experienced claim professionals are usually surprised at how accurately the model predicts recovery. The validation chart below, taken from live data, shows how closely disability claim scoring tracks to actual recovery.

How Claim Scoring is Used

Claim scoring is used to:

• Focus resources on areas of maximum return
• Quickly establish a starting point for a new claim
• Balance the workload
• Facilitate early intervention
• Fine-tune management strategy

How the Model is Built

The process begins with a data extract from your claims database.

The extract includes fields such as age, gender, diagnosis, etc. for each claim. From this data, we build you a predictive scoring model.

During development, the tools used in the model repeatedly examine your block of historic claims, searching for relationships between:

• input factors (age, diagnosis, occupation, etc.), and
• whether the claimant returned to work.

After many thousands of iterations, the model is able to identify and quantify relationships among these factors, and thereby accurately predict the likelihood of return to work for new claims.

Implementing Claim Scoring

We score your current cases, and establish a schedule to score new cases. We begin to send you scoring reports.

To offer you assistance in starting with claim scoring, and in taking greatest advantage of its benefits, we can include start-up assistance from an expert in the field in your scoring package.

Fields Used in the Model

Required Fields

• Date of disability
• Elimination period
• Current status, reason and date
• Age (or date of birth)
• Diagnosis

Helpful Fields

• Diagnostic category
• Secondary and tertiary diagnoses
• Date claim reported
• Occupation class
• State or province
• Zip or postal code
• Gender
• Monthly earnings
• Monthly benefit from insurer
• Benefits received from other sources
• Smoking habits
• Industry
• ASO vs insured
• Are benefits taxable
• Previous claims by claimant
• Prescription drug history

Your Model is Tailored

Each claim scoring model is tailored to your data. Data is not shared among models. No two models are the same.

One-Minute Claims Manager

Forecasting Return to Work with Predictive Modeling By Barry Senensky and Jonathan Polon