Uses of Claims Reserves Case reserves are used by the rating bureaus to help determine the pricing of workers compensation insurance. Their calculation uses the case reserves on the clams files at 18 months after the inception of the insurance policy. Actuaries rely on claims reserves to help determine the projected ultimate cost of the claims. They calculate a reserve loss development factor which is applied to the case reserves.…
There is a paramount importance of quality data in the context of Risk Management / Workers' Compensation and driving advancements in artificial intelligence (AI) within the industry. There is an urgent need for a standardized data glossary and data collection practices. Reliable data will have a direct impact on the development and implementation of AI solutions. Due to a lack of consistent data definitions or a data glossary, there are significant…
AI is revolutionizing the landscape of the workers' compensation industry. I am particularly optimistic about the positive impact it will bring. While acknowledging that there are many challenges, I firmly believe that AI will ultimately lead to significant benefits for injured workers and substantial cost reductions within the system. As an experienced Risk Manager and GVP of Claims at insurance companies, I've witnessed the evolving dynamics of our industry firsthand.…
Artificial intelligence relies on data to do its job. Some of the known problems with the use or management of AI are the lack of quality data and the embedded biases in the existing data. Timely and accurate data collection using a common data glossary would allow employers, insurance companies, claims administrators, and vendors to perform better internal analysis of their staff productivity, compare claims results, compare benefit provision, determine…
AI represents the future of workers’ compensation. However, like all new technologies, AI is not without its challenges and detractors. Here are a few considerations as we embark on this transformative journey. Data Privacy and Security: It is crucial to ensure the privacy and security of the sensitive data that AI systems use. Data privacy issues apply to both the products of the AI process and the data AI uses…
All new technology has both positives as well as negatives. Many times during the initial development of the technology the negatives are unknown or not understood. With this concept in mind, the JASON think tanks were instituted by the US Government to deliberately review all new technologies to determine how they could be weaponized against the USA* I highly recommend you read some of their declassified reports. Prominent tech leaders…
In today's business landscape, the ability to quantify risks in financial terms is crucial. With this information, the business can focus appropriate resources to mitigate enterprise-wide risks by shifting the risk to another company or by reducing the risk through improved operational efficiency. While businesses inevitably bear the costs of risk in their operations, the question is, what is the monetary value of managing these risks, and how can they…
Best Practices for claims departments to maximize the effectiveness of an audit With commentary and insight from Rick Sabetta and Barry Bloom As a Claims Supervisor I reacted very poorly to my first workers compensation claims audit. I went through the familiar stages that one does when first audited: Anger (at how anyone could question my decisions or results) Denial (that someone in my claims unit had made mistakes) Negotiations (over…
by Bill Zachry, SCIF Board Member and Barry Bloom, Managing Partner, The bdb Group “As the claims manager goes, so goes the office.” The most important job in a workers’ compensation claim office is the claims manager. Most companies strive for consistency and accuracy with regard to benefit provision. They work hard to achieve these results while trying to maintain a low cost of claims administration. To accomplish these results, they establish policies…
Management Engagement: The approach and attitude that senior management takes regarding injury prevention, safety, employee welfare, interaction with injured workers, and treatment of claims partners are primary determinants of successfully managing the workers' compensation program. Hiring the Right Employee: Hiring qualified and engaged employees is essential for reducing the risk of workplace injuries and subsequent workers' compensation claims. In today’s employment market this can be a particular challenge. Safety and…
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