How Insurers can Improve Demand Package Review Results for Injury Claims

It takes substantial resources to get a complete picture of the medical history and relevant data in a case to properly review demand packages—especially for today’s adjusters who struggle with high caseloads, rising bodily injury severity, and increasing health care costs.

More than 50 percent of bodily injury claimants hire attorneys, and auto bodily injury claim severity has risen to $20,235 on average. Meanwhile, claims organizations continue to experience a talent crisis.

This article will explore the challenges of reviewing complex demand packages and new technology that can help simplify the process.

The complexities of reviewing demand packages

As cases move toward a settlement, bodily injury adjusters receive complicated demand packages from claimant attorneys. They’re challenged to quickly review page after page of medical records to find the details they need to evaluate the claim properly.

Additional complications arise when adjusters of varying experience levels evaluate claims differently – especially for more complex cases such as claimants with compound injuries or pre-existing conditions.

Furthermore, medical damage demands on liability claims are often based on the worst-case scenario, assuming all medical treatment is necessary and related to the accident. It can be difficult to push back against these demands because the cases are often complex.

Simplify demand package reviews with new technology

Advanced technology can help claims teams boost efficiency and accurately resolve injury evaluations and settlement negotiations—saving time, money, and resources.

For example, one solution automates medical information retrieval through sophisticated AI, pulling key data quickly from medical records and providing adjusters with the information they need in a format that can be quickly reviewed and uploaded into their claims management system.  

Key capabilities of this solution include:

• Automated extraction of crucial medical information from patient files
• Retrieval of information like ICD Codes, medications, comorbidities, and more
• Term tagging to allow filtering by type of medical term
• Identified information available in an easily uploaded table or document

Make accurate, data-based decisions with robust analytic solutions

In today’s fast-paced claims departments, making consistent, data-based decisions is critical, especially when those decisions require adjusters to analyze bodily injury information to derive consistent settlements.

Insurers would benefit from using a system that compares incoming claims to a company’s historic claims and provides critical insights. Those insights empower claim handlers to produce more consistent general damage assessments, receive settlement guidance for consistent resolutions, and strategize the best negotiation approach.

Improve quality claim handling

To help clients improve on quality claim handling, with improved consistency plus lower manual efforts use a technology that unravels complicated medical claims and allows insurers to get a snapshot or a full review of records from an experienced Registered Nurse. The report generated provides insurers with objective analysis and opinion regarding the necessity of treatment and recommendations rendered, along with literature to support the findings.

By Mike Rivers

Courtesy of Verisk

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