New Research Shows that Proactive Identification and Management of Back Claims can Reduce Costs by 33%

Share Article

York Risk Services Group, a leading provider of claims management, managed care and risk control services, today announced new research showing that the combination of sophisticated predictive analytics and early, expert medical assessment significantly reduces both the cost and duration of workers’ compensation back claims.

York

York Risk Services Group, a leading provider of claims management, managed care and risk control services, today announced new research showing that the combination of sophisticated predictive analytics and early, expert medical assessment significantly reduces both the cost and duration of workers’ compensation back claims. York calls this approach “TeamComp.” In the study, which looked at 24 months of TeamComp back claim data:

  • The average medical paid decreased 29% from $7,923 to $,5,631,
  • The average total paid decreased 33% from $14,301 to $9,605, and
  • Lost days decreased 35% from 64 days to 42 days.

The full report is published in the whitepaper TeamComp Significantly Reduces the Cost and Duration of Back Claims,” which is available on RiskCentral.com, the risk management information hub from Risk & Insurance Magazine.

“The key to TeamComp’s success is the way we integrate predictive analytic intelligence and medical expertise into the overall claims management process,” explains Doug Markham, President of Managed Care for WellComp, York’s provider of managed care services. “TeamComp automatically alerts a dedicated team of clinical review nurses whenever a claim is flagged by our analytic engine. The review team’s medical expertise allows them to triage the claim and partner with the adjuster to make the best decision about how to manage the claim to a positive outcome. Where it will help drive the claim to a better outcome, the adjuster can also assign a case manager to provide an additional level of medical expertise and guidance.

Focusing Solutions on the Biggest Problem
“We chose to look at back claims because they are such a significant driver of costs for employers,” says Todd DeStefano, President of York’s Risk Management Practices division.

The most frequently reported and treated occupational health injury in workers’ compensation is back pain, and approximately 33% of workers’ compensation dollars are spent on lower back injuries. Almost half of the claims associated with back injuries result in lost work time.

Some of the key variables driving up costs of back claims are the difficulty in obtaining a reliable diagnosis of the cause of the back issue, as well as the timing and the appropriateness of the treatment injured workers receive at the outset of and throughout the claim. “TeamComp allows us to address all three factors,” notes Markham. “Because TeamComp continually reviews every open claim, our analytics can immediately flag claims where the treatment plan is not producing the expected results. This allows us to work with the provider to stop ineffective treatment and redirect the injured worker to a provider or approach that will be more effective,” he adds.

The last component of the TeamComp approach is the partnership between adjuster, case manager and network provider to design light duty or modified duty jobs that expedite the injured workers return to work. York’s aggressive and successful focus on return to work is a key component in reducing indemnity payments as well as lost time days and the impact on overall productivity.

“York’s focus has always been on delivering superior outcomes and reducing our clients’ total cost of risk,” said DeStefano. “Our ability to seamlessly incorporate managed care information and services into our claim management solutions has been a cornerstone of that effort. TeamComp, by allowing us to identify problem back claims earlier in the process and proactively manage them, takes those efforts -- and the attendant results -- to the next level.”

About York Risk Services Group
York Risk Services Group Inc. is a premier provider of risk management, claims handling, specialized loss adjusting, managed care, pool administration, loss control and other insurance services nationwide. York provides risk management and managed care solutions to a variety of strategic partners, including insurance carriers, self insureds, brokers, wholesalers, MGAs, programs, risk pools and public entities. The third largest TPA in the U.S., York delivers customized claims solutions for all lines of business, including property, liability, products liability, ocean and inland marine, environmental, transportation and logistics, construction and workers’ compensation. Based in Parsippany, New Jersey, York has over 90 offices in the US and a strong international presence. Visit York on the web at http://www.yorkrsg.com.

For more information contact:
Anne W. Ellis, CPCU
Assistant Vice President
Marketing and Communications
York Risk Services Group, Inc.
973-404-1282
Anne(dot)ellis(at)yorkrsg(dot)com

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Anne Ellis
Visit website