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Historical Claims Analysis


A comprehensive process of identifying, pulling & compiling information from multiple sources that is then organized to facilitate a constructive, multi-tiered analysis using a custom data management tool. The analysis will identify cost-driving claim trends, individual claim characteristics & effectiveness of claim processes.  Once completed, it becomes a roadmap for fundamental process change and measurement of future success. 


It's not cursory data posted to a flow chart.  It's not a high-level discussion that lacks substance, nor is it a process that fails to capture your full financial loss or the very real human costs of bad outcomes.




The requirements for this process are not always readily available or accessible.  There are facts and circumstances in each case and a number of inter-dependencies that may contribute to less than optimal claim outcomes.  The employer, employee, medical provider, insurer & case manager may all impact the claim. 

To discern cause & effect, you need to know what to look for, where to find it, & how to engage those involved to ascertain useful information.  We know where to get the data, how to get the data, all inherent impediments to good outcomes, and how to secure constructive anecdotal data from those involved.

A critical source of reliable information are the company’s employees.  They have first hand, often irreplaceable knowledge of an injury, its severity, contributors to lost time and injury duration, an employee's level of engagement, that of the care provider(s) and what procedures were or were not performed and why.   

Once information is compiled and organized, we apply our set of advanced worker’s compensation metrics.  These metrics provide a precise measurement of claim activity to guide our understanding of historical claim performance and the status of active claims.  Prospectively, they help weight/prioritize areas of opportunity, and may further serve as a benchmark for measuring the efficacy of program enhancements. 


  1. There is not a one size fits all approach to a historical case review.

  2. There are multiple approaches & pathways, as well as varying levels of detail.

  3. We want to structure a plan & approach that will yield the most value and effective ROI.

  4. Initial analysis and discussions may even suggest prioritizing critical areas & defer parts of the review.

  5. A preliminary review of active cases may actually take precedence as to favorable impact

  6. We will meet first, prioritize & select the pathway & approach best suited for your organization.


  1. Initial interview, defining requirements, prioritization, & process planning.

  2. Plan consensus including document & records request

  3. Review of multi-source claim data retrieval process & production

  4. Formal Data analysis, interview & record review

  5. Follow up & cleanup of data compilation and organization

  6. Report generation, vetting & validation of information and findings with key employees

  7. Final Delivery of report, data base and recommendations

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