#GuidewireConnections: Driving better outcomes for workers’ compensation


The expense of accident and workplace injury and death exceeds $1.25 trillion USD per year worldwide. The costs of these injuries include not just medical management, but lost productivity as well as a reduction in work-life capabilities and personal enjoyment.

There are 270 million accidents and 160 million work-related diseases (dust, cancer, etc.) reported annually, with more than 2 million lives lost from workplace accidents, according to estimates by the International Labour Organization.

These are significant numbers. And it’s statistically proven that those countries with lower accident rates have resulting higher gross domestic product (GDP).

Obviously, people who are injured and are not working are also not producing goods and services; therefore, a positive reduction in a number of days lost due to injury will ultimately result in a country’s improvement in their overall gross domestic product. If you can return injured workers to the workplace earlier – by even just one day – you can easily make a case that this would add $100m USD back into the world’s economy.

The insurance industry needs to take a more innovative approach to addressing how to control the astronomical costs and improve business outcomes of workers’ compensation. But how do you do that?

The answers are hiding in plain sight: Data.

Use of predictive analytics to provide proven treatment plans and preventative measures

Of course, I’m not assuming you’re like Keanu Reeves’ character in The Matrix, able to glean insights by simply looking at streams of binary data. What I’m talking about is predictive analytics.

Today’s injured employee is likely to be older, in poorer health, and at higher risk for a complex injury or claim than in previous decades, according to Property Casualty 360. The use of predictive analytics allows claims managers to identify potential complicating factors about an individual’s condition up-front, enabling them to take these risks into account and create a more proactive approach to their ongoing treatment plans.

You can also use the same data and insights to determine the best methods for recovery and apply them to a return-to-work plan to reduce the risk of re-injury. Insights from predictive analytics also identify “routine” claims that have the potential to become complex, as well as patterns in types of injuries that can be corrected to reduce cost and improve outcomes.

Timely, efficient reporting and processing of claims

When a company experiences a workers’ compensation claim, it affects more than just the injured employee. From an employer’s perspective, there is lost production and continuity, increased costs and resource strains. There can also be a significant financial impact on delayed reporting of a work cover claim, including higher costs and missed opportunities to mitigate medical spending.

A claim can also lead to increased employee anxiety, confusion and ultimately unnecessary litigation.

To minimize claims, you need to do more than just be predictive. By integrating your core systems with enterprise content management on the back-end, your organization:

  • Processes claims quicker and more efficiently
  • Increases claimant responsibility through self-determination programs
  • Enhances information and analytics for treatment plans and rehabilitation
  • Becomes more preventative and proactive
  • Increases loss control

In turn, all of these measures will also lead to improved life outcomes, which is the ultimate goal.

Keep claim costs down by closing them quickly

Delayed reporting significantly increases workers’ compensation claim costs, according the National Council on Compensation Insurance. The lowest median cost is for claims reported in the first two weeks.

More than half of claims reported within the first two weeks close within 18 months. However, only 29 percent of claims reported more than a month after the accident close within the same timeframe.

By using the innovation of digital portals, insurers can provide state-of the art capabilities for employers, injured workers, medical practitioners and case workers to more effectively initiate, gather and collaboratively share information. Empowering these groups with the ability to work together improves claim reporting and speeds processing.

Expedite healing and an earlier return to work

Employees who are satisfied with the overall response to injury or illness return to work 50 percent faster with 54 percent lower cost. Medical treatment within specialized occupational medical clinics familiar with treating workers’ compensation injuries may result in quicker healing and an earlier return to work.

Also, claimants who have accountability for their own recovery through self-determination and are empowered to make their own decisions regarding care show improved times in returning to work quicker.

With Guidewire and OnBase working together, you can make defined guidelines for suggested treatment protocols immediately available at the time of diagnosis, enabling injured workers to have treatment plans in their hands – including the expected return-to-work date. All the supporting information is immediately transferred to the insurer so the purchase plan for treatments are pre-approved and payment is scheduled. You can even automatically provide recommended support groups to enhance rehabilitation while return-to-work statistics are automatically provided.

Modernization of workers’ compensation platforms is a requirement if the global insurance market is to ensure future success, provide the ability to reduce and manage costs and most importantly, improve life outcomes.

The combined effort of industry leaders like Hyland and Guidewire is bringing to market the most comprehensive integrated and most innovative solutions the industry has seen in decades.

We’re still here at Guidewire Connections. Come see us at booth P2 to learn more!

Ruth Fisk

Ruth Fisk has more than 25 years of experience working within the insurance industry and is a foremost expert on the practical application of EDMS technology. In her role as... read more about: Ruth Fisk