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Do Work Comp Claim Analytics Really Work As Promised


Have Work Comp Claim Analytics Arrived?

A Work Comp Claim Analytics package is something that I have been in search of for many years.   Can software actually replace the thinking process of an experienced adjuster?

Hand Illustrating Work Comp Claim Analytics Concept

Last year at the 2015 WCRI Conference I met a few analysts for one of the big insurance carriers.    They had informed me the carrier was working on a database for “internal” work comp claim analytics.  The package was not going to be sold to the public.

Last week, I noticed an article from a major third party administrator that is selling a claims analytics package.   A few weeks ago I wrote about not being able to find any accurate analytics  or predictive model packages.

Vector Graphic Of Work Comp Claim Analytics With Dollar Sign

Some of the comments on the article suggested that there are great analytics on the front end (policies, loss portfolio, underwriting) .  That may be true but I have yet to see any worthy claim analytics package.

However, if a TPA or insurance carrier had enough data, one would have to think they would be able to at least see if an injured employee fit some type of profile such as drug dependent personality or if a person from a certain zip code would take longer to heal than the expected norms.

I have demoed so much software at the National Workers Comp Conferences without really finding an analytics program for claims.  One reason is the limited amount of data that the vendors would have had – except for the large TPA’s and carriers.

I will eventually have to let go of the old school  way of thinking that an experienced adjuster is the best way to analyze a workers comp file and its associated reserves.  Once I see a package that works, I will keep quiet about work comp claim analytics.   Until then, I will keep commenting and searching.

Related: Workers Comp Predictive Analytics Changed Loss Run Reviews Forever

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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